Sebastian Savitha A, Sumithra S, Kurian Jithu, Mathew Vivek, Idiculla Jyothi M
Department Of Medicine, St John's Medical College, Bengaluru 560034, Karnataka, India.
Department of Biostatistics, St John's Medical College, Bengaluru 560034, Karnataka, India.
Natl Med J India. 2018 May-Jun;31(3):136-139. doi: 10.4103/0970-258X.255753.
Thyroid dysfunction in patients with human retroviral infection has been reported but the prevalence of thyroid function abnormalities in patients on highly active antiretroviral therapy (HAART) has not been studied. We aimed to assess the prevalence of thyroid dysfunction and autoimmunity (antithyroid peroxidase auto-antibodies [TPO-Ab]) in patients on first-line HAART, identify risk factors for thyroid dysfunction and determine any association of thyroid dysfunction with HAART.
We screened and enrolled consecutive patients from the outpatient department if they were (i) diagnosed with HIV infection (enzyme-linked immunosorbent assay); (ii) aged more than 18 years; (iii) on HAART for 1 year or more; and (iv) clinically stable with no evidence of any acute illness in the past 2 months. We excluded patients who were on drugs that affect thyroid function. Thyroid function tests and CD4 counts were done.
A total of 159 patients on firstline HAART were included in the study. Their mean (SD) age was 43.3 (10) years and duration of HAART was 44.4 (33.54) months. The mean CD4 count was 502.8 (274.45). Forty-seven patients (29.6%) had thyroid dysfunction. TPO-Ab positivity was noted in 6 patients. No association was seen between thyroid dysfunction and any type of regimen or drug. There was a significant negative correlation between CD4 counts and thyroid-stimulating harmone (TSH) suggesting that thyroid dysfunction may be more prevalent when immunity is low.
There is a high prevalence of thyroid dysfunction, predominantly subclinical hypothyroidism, in patients on HAART. Thyroid autoimmunity is low in this subset of patients. Lower immunity is associated with higher TSH levels. Larger longitudinal studies are required to determine the course of hypothyroidism in patients on HAART.
已有报道称人类逆转录病毒感染患者存在甲状腺功能障碍，但尚未对接受高效抗逆转录病毒治疗（HAART）的患者甲状腺功能异常的患病率进行研究。我们旨在评估接受一线HAART治疗的患者甲状腺功能障碍和自身免疫（抗甲状腺过氧化物酶自身抗体[TPO-Ab]）的患病率，确定甲状腺功能障碍的危险因素，并确定甲状腺功能障碍与HAART之间的任何关联。
我们对门诊连续就诊的患者进行筛查并纳入研究，条件为：（i）诊断为HIV感染（酶联免疫吸附测定）；（ii）年龄超过18岁；（iii）接受HAART治疗1年或更长时间；（iv）临床稳定，过去2个月内无任何急性疾病迹象。我们排除了正在服用影响甲状腺功能药物的患者。进行了甲状腺功能测试和CD4计数。
共有159名接受一线HAART治疗的患者纳入研究。他们的平均（标准差）年龄为43.3（10）岁，HAART治疗时间为44.4（33.54）个月。平均CD4计数为502.8（274.45）。47名患者（29.6%）存在甲状腺功能障碍。6名患者TPO-Ab呈阳性。未发现甲状腺功能障碍与任何类型的治疗方案或药物之间存在关联。CD4计数与促甲状腺激素（TSH）之间存在显著负相关，表明免疫力低下时甲状腺功能障碍可能更为普遍。
接受HAART治疗的患者中甲状腺功能障碍的患病率很高，主要为亚临床甲状腺功能减退。该患者亚组的甲状腺自身免疫较低。免疫力较低与较高的TSH水平相关。需要进行更大规模的纵向研究来确定接受HAART治疗患者甲状腺功能减退的病程。
