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D. Saverino, R. Brizzolara, R. Simone, A. Chiappori, F. Milintenda-Floriani, G. Pesce and M. Bagnasco, “Soluble CTLA-4 in Autoimmune Thyroid Diseases: Relationship with Clinical Status and Possible Role in the Immune Response Dysregulation,” Clinical Immunology, Vol. 123, No. 2, 2007, pp. 190-198. doi:10.1016/j.clim.2007.01.003

has been cited by the following article:

• 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.