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  3rd International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV
Athens, Greece - October 2001
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High prevalence of Thyroid Abnormalities in the era of HAART
  This pilot study reported patients with HIV appear to have higher risk than general population for thyroid abnormalities. The rate in the general population is 1% for females and 0.2% for men. In this study 12% had thyroid abnormalities and 5% had hypothyroidism. The data from this study suggests an association of hypothyroid abnormalities with having HIV, duration of HIV, and lipodystrophy. 51% with lipoatrophy had thyroid abnormalities vs 21% who had lipoatrophy but no thyroid abnormality. These results raise a concern about HCV/HIV coinfected patients. Thyroid problems can emerge at a low rate when patients receive HCV therapy.
E Billaud and a French research group reported at Athens on the incidence of throid abnormalities in HIV in their study. Billaud said recent reports have outlined a high frequency of thyroid dosirders in Hiv patients treated with HAART. This prospective study was conducted to better determine the prevalence of thyroid abnormalities.
This is a cross-sectional study of 221 HIV-infected patients (163 men, 58 women) with a mean age of 40. It is a single center pilot study where data was collected from October 1, 2000 to January 1, 2001. They evaluated general condition, hypothyroidism, and retinoid symptoms. Physician assessment of lipodystrophy was made, a fasting lipid profile and glycemia were collected, and free thyroxin (FT4) and thyrotropin were evaluated.
Hypothyroidism was defined as a thyrotropin level greater than 4IU/I and free thyroxine below 8.5 pmol/l.
Subclinical hypothyroidism was defined as isolated elevation of thyrotropin and asymptomatic.
Transient hypothyroidism was defined as low free thyroxine not persisting after control
1+2+3 equals biologocal thyroid abnormalities.
--Mean CD4 457
--Mean viral load 1,000 copies/ml (3.03 log)
--Treatment-naïve patients 9%
--85% were taking NRTIs
--34% were taking NNRTIs
--42% protease inhibitors
RTV (100-600) 26%
IDV 16%
SQV 10%
NFV 8%
APV 4%
Kaletra 2.3%
       (-# = Mean)
Time from seroposivity (months) - 91
Time from HIV-infection (months)- 112
Treatment time (months)- 50
Cumulated PI therapy (month)- 19
BMI (body mass index)- 22
Thyrotropin (0.2- 4 UI/ml)- 2.29
Free thyroxine (8.5-18 pg/ml0- 10.73
Cholesterol (1.41-2.82 g/l)- 2.26
Triglycerides (0.40-1.6 g/l)- 3.13
HDL cholesterol (0.42-0.66 g/l)- 0.47
LDL cholesterol (1.11-1.88 g/l)-1.25
Glycemia (0.7-1 g/l)- 0.90
Hemoglobin (12-17.5 g/dl)- 14.2
Of 221 patients there were -
  • 27 biological thyroid abnormalities (12.2)
  • 12 hypothyroidisms (5%); 6 opotherapy
  • 7 subclinical hypothyroidisms (3%)
  • 8 transient abnormalities (4%)
  • 2 hyperthyroidisms excluded from statistical analysis

29.6% with thyroid abnormalities were female and 26% without thyroid problem were female. 74% with thyroid problem were on a PI for more than 3 months while 56% without thyroid problem were on a PI for more than 3 months. 13% with thyroid abnormalities had iodinated contrast and 6.5% without thyroid abnormality had iodinated contrast. 29% with thyroid abnormality had ocean proximity and 14.5% with no thyroid problem had oceanproximity. These differences were not statistically significant.
0% with thyroid problem had cramps and 9.4% without thyroid problem had cramps. Constipation: 11% w/thyroid abnormality, 9.4% w/o thyroid abnormality. Constipation; 11% w/thyroid abnormality, 6.8% w/o thyroid abnormality. Slowing down: 0% w/thyroid abnormality, 4.2% w/o thyroid abnormality. Weight gain: 7.4% w/thyroid abnormality. 13.5% w/o thyroid abnormality. None were statistically significant.
Retinoid Symptoms
Mucosal dryness: 0% w/thyroid abnormality, 9.4% w/o thyroid abnormality Nail weakness: 0% w/thyroid abnormality, 3.6% w/o thyroid abnormality.Skin dryness: 14.8% w/thyroid abnormality, 13% w/o thyroid abnormality. Perionyxis: 0% w/thyroid abnormality, 0.5% w/o thyroid abnormality.
Age (p-0.028)and time from seropositivity (p-0.034) were the only two factors correlated with abnormalities after multivariate analysis. This suggests HIV or duration of HIV may play a role.
CLINICAL LIPODYSTROPHY- 51.9% with lipodystrophy had thyroid abnormality vs 26.6% with lipodystrophy who did not have thyroid abnormality (p=0.01).
ClLINICAL LIPOATROPHY: 51.9% w/ lipoatrophy had a thyroid abnormality vs 21.4% who had lipoatrophy without a thyroid abnormality (0.002).
CDC Stage C AIDS appears associated with thyroid abnormality: 48% with thyroid abnormality were CDC stage C while 20% w/o thyroid abnormality had CDC Stage C. For patients who were CDC Stage A and B, there was no difference in percent with thyroid or w/o thyroid abnormality (p=0.02).
5% prevalence of hypothyroidism in this study. The rate in the general population is 1% among females and 0.2% among men. Subclinical hypothyroidism could be a risk factor for heart disease in the elderly.