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Autoimmune Thyroid Disease Occurring as a Late Complication of Immune
Reconstitution Disease in HIV Patients
Clinicians
have noted that some of their patients experienced a clinical decline
soon after starting HAART, even though these individuals had low
HIV RNA levels and rising CD4 T cell counts. In these individuals,
HAART
caused a pathological inflammatory response to either previously
treated infections or subclinical infections. The inflammation,
which can result in adverse clinical outcomes, has been labeled
immune reconstitution
disease (IRD) or immune reconstitution
inflammatory syndrome (IRIS).
In
addition, researchers have a built a model for a better understanding
of the pathogenesis of autoimmune diseases. Important factors in
their construct are genetic predisposition, molecular mimicry and
immune dysregulation..
In
the current study of the "late" manifestation of autoimmune thyroid disease (AITD)
in a cohort of HIV positive patients following the introduction
of HAART, British researchers discuss how immune dysregulation and
factors associated with the immunopathology of HIV infection fit
the current understanding of autoimmunity and provide a plausible
basis for clinical observations.
De
novo diagnoses of thyroid disease were identified between 1996 and
2002 in 7 HIV treatment centers in the UK (5/7 centers completed
the study). Patients were diagnosed as clinical case entities and
not discovered through thyroid function test screening.
17
patients were diagnosed with AITD (median age, 38 yr; 65% were of
black African or black Caribbean ethnicity; and 82% were female).
The median duration of immune reconstitution was 17 months.
The
mean baseline pre-HAART CD4 count was 67 cells/mL, and the mean
increase from nadir to AITD presentation was 355 cells/mL. AITD
patients were more likely than controls to be severely compromised
at baseline (as defined by a CD4 count < 200 cells/mL or the
presence of an AIDS-defining diagnosis, and to experience greater
CD4 increments following HAART.
In
conclusion, the authors write, AITD may be a late manifestation
of immune reconstitution in HIV-positive patients taking HAART,
and immune dysregulation may
be an important factor.
From
Department of Genitourinary Medicine (FC, GS, CJL), St. Mary's Hospital,
London; Department of Genitourinary Medicine (SLD, AdR), Guy's &
St. Thomas' Hospital NHS Foundation Trust, London; University of
Sheffield (RAM), Division of Clinical Sciences (North), Northern
General Hospital, Sheffield; Department of Genitourinary Medicine
(FC, MSK), Northwick Park Hospital, London; Department of Genitourinary
Medicine (FC, MGB), Central Middlesex Hospital, London; The Lawson
Unit, Department of Genitourinary Medicine (DC), Royal Sussex County
Hospital, Brighton; Department of Endocrinology & Metabolic
Medicine (SR), St. Mary's Hospital, London; Imperial College School
of Medicine (SLD, CJL), London; Hull York Medical School (CJL),
University of York; The Medical School (APW), University of Sheffield,
Sheffield, United Kingdom.
See also
Incidence,
Risk Factors and Long-term Outcome of a Unique, HAART-related Disease:
Immune Reconstitution Inflammatory Syndrome (IRIS)
03/16/05
Reference
F
Chen and others. Characteristics of Autoimmune Thyroid Disease Occurring
as a Late Complication of Immune Reconstitution in Patients With
Advanced Human Immunodeficiency Virus (HIV) Disease. Medicine (Baltimore)
84(2): 98-106. March 2005.
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