TITLE:
Graves’ Disease as a Late Manifestation of Immune Reconstitution Syndrome after Highly Active Antiretroviral Therapy in an HIV-1 Infected Patient
AUTHORS:
Evelin Mingote, Agustina Urrutia, Alejandra Viteri, Cristina Faingold, Carla Musso
KEYWORDS:
Graves’ Disease; Immune Reconstitution Syndrome; Highly Active Antiretroviral Therapy; HIV-1; Lipodystrophy Syndrome
JOURNAL NAME:
World Journal of AIDS,
Vol.3 No.3,
August
9,
2013
ABSTRACT: Context: Highly active antiretroviral therapy (HAART) inhibits
the HIV replication and consequently increases CD4 levels and decreases viral
load. This immune system improvement can trigger various immunological
phenomena, entity called Immune Reconstitution Syndrome (IRS). Graves’ disease
is a late Immune Reconstitution consequence. Patient: We
report the case of a 48 years old man with HIV infection who developed Graves’
disease three years after he was on effective HAART because of the Immune
Reconstitution Syndrome. At presentation he had a very low CD4 T-cell count (17 cells/μL). When he started HAART he
presented a lipodystrophy syndrome. HAART was changed because of the
persistent low CD4-T cells count (less than 100 cell/μL). Afterwards serum
lipid levels began to decrease and that was the first manifestation of Graves’
disease, which was diagnosed when CD4 T-cells increased up to 343 cell/μL. Our patient
developed Graves’ disease 36 months after initiating effective HAART with
protease inhibitors which was coincident with
viral suppression and a rise of CD4 T cells. Conclusion: The most
immunosuppressed patients with a CD4 T cell count less than 100 cells/μL are at greatest risk for the development of Immune
Reconstitution Syndrome after HAART initiation. We conclude that clinicians will have to
consider the importance of the early diagnosis of thyroid disease to bring an
adequate treatment.