Chen F, Day SL, Sethi G, Tong CY, Simpson H, Metcalfe RA, Welch J, Edwards SG, Lewis DA, Scullard G, Lacey CJ, Weber JN, Weetman AP, Robinson S, Kapembwa MS, de Ruiter A; International Conference on AIDS.
Int Conf AIDS. 2002 Jul 7-12; 14: abstract no. ThPeA7149.
Department of GU Medicine, St. Mary's Hospital, London, United Kingdom
BACKGROUND: Autoimmune thyroid disease (AITD) has been observed in HIV+ patients taking HAART leading to suggestion that immune reconstitution (IR) might facilitate organ-specific autoimmunity. METHODS: All cases of newly diagnosed AITD in 6 HIV treatment centres were identified. Data was collected on the clinical spectrum, thyroid function, CD4 count (cells/ml), plasma HIV RNA viral load (VL), thyroid antibody (Ab) and technetium scans. Ab to microsomal, thyroglobulin and thyroid stimulating hormone receptor (TSHR) were also assayed from paired archival samples by one laboratory. RESULTS:10 pts with thyrotoxicosis (9 female and 1 male) were identified. Median age 37 (range 33-53). All pts were taking HAART. The median CD4 count prior to HAART commencement was 50 (range 1-215). The median time (months) from first VL <50 to diagnosis of AITD was 14 (range 14-32) and mean increase in CD4 count was 311 (44-680). Clinically, Graves' Disease (GD) was diagnosed in 9 pts (8 female, 1 male). One GD pt had a rarely seen association of profound secondary hypoadrenalism (plasma ACTH < 20ng/l). 2 pts developed GD 8-12 months after childbirth. 1 pt developed autoimmune thyroiditis. She became profoundly hypothyroid 3 weeks after thyrotoxic phase, giving a Hashi-toxicosis picture. 8 pts showed sequential rise in Ab titres. Very high TSHR blocking Ab titres, not previously recorded, were observed in 2 pts (73.5 and 48.5, range >1,<2 stimulation index). CONCLUSIONS: Knowledge of prevalence data of AITD in HAART naive patients is needed. However, our observations of varied and rare AITD phenotypes, in a credible temporal and epidemiological setting, appear unlikely to be chance observations and the overlap of their natural history with the main phase of naive CD4+ lymphocyte release, makes IR-AITD a biologically plausible phenomenon. Detecting autoreactive clones during IR may improve understanding of autoimmunity.
Publication Types:
Keywords:
- AIDS Vaccines
- Acquired Immunodeficiency Syndrome
- Antibodies
- Antiretroviral Therapy, Highly Active
- Autoantibodies
- Autoimmune Diseases
- CD4 Lymphocyte Count
- Female
- Graves Disease
- HIV Infections
- HIV Seropositivity
- Humans
- Hypothyroidism
- Male
- Receptors, Thyrotropin
- Thyroglobulin
- Thyroiditis, Autoimmune
Other ID:
UI: 102252190
From Meeting Abstracts