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%
(-# = 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 -
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.
- 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
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.
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.