Graves’ disease during immune reconstitution after highly active antiretroviral therapy for HIV infection: evidence of thymic dysfunction
Abstract
A patient with HIV infection who experienced immune reconstitution after highly active antiretroviral therapy (HAART) [increase in CD4 T cell count from <1/microl to >600/microl] presented with severe Graves' disease 32 months after commencing HAART. A comprehensive clinical and laboratory study demonstrated pronounced regional lymphadenopathy and thymic enlargement at presentation, and that the onset of thyrotropin receptor antibody production was associated with increased production of soluble CD30 (a marker of type 2 immune responses). Blood naive CD8 T cell counts and TREC levels in both CD4 and CD8 T cells were increased at multiple time points compared with carefully selected controls. We conclude that the Graves' disease in this patient was associated with abnormally high blood counts of thymus-derived T cells, and propose that Graves' disease after HAART in this and other HIV patients may result from failure to delete autoreactive T cell clones in the regenerating thymus.
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Among HIV patients, Graves' disease occurred 8-33 months (mean 17 months) after HAART initiation.
“Among HIV patients GD occurred 8-33 months (mean 17 months) after HAART initiation [15-21].”
From 2019 European Thyroid Association Guidelines on the Management of Thyroid Dysfunction following Immune Reconstitution Therapy (2019) · cites this paper as [18]
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- Authors
- French, M. A., Lewin, S. R., Dykstra, C., Krueger, R., Price, P., & Leedman, P. J.
- Affiliations
- The University of Western Australia (AU)
- The Royal Melbourne Hospital (AU)
- Royal Perth Hospital (AU)
- The University of Melbourne (AU)
- Venue
- AIDS Research and Human Retroviruses
- Publisher
- SAGE Publications
- Published
- 2004-02
- Volume
- 20
- Issue
- 2
- Pages
- 157-162
- ISSN
- 0889-2229 (ISSN-L)
- 1931-8405
- OpenAlex
- W2079169004
- Cited by
- 59
- References
- 48
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 1 · 2021: 2 · 2020: 3 · 2019: 1 · 2018: 1 · 2016: 1 · 2015: 3 · 2014: 5 · 2013: 7 · 2012: 3
- FWCI
- 1.85
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- AIDS Research and Human Retroviruses (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Topics
- Life Sciences › Immunology and Microbiology › Virology › HIV Research and Treatment
- Life Sciences › Immunology and Microbiology › Immunology › T-cell and B-cell Immunology
- Health Sciences › Medicine › Emergency Medicine › HIV-related health complications and treatments
- Keywords
- Graves' disease, HIV infection, highly active antiretroviral therapy, immune reconstitution, thymic dysfunction, thymic enlargement, TSH receptor antibodies, soluble CD30, Th2 immune response, thymic emigration, thymic selection, TREC, CD8+ T cells, lymphadenopathy
- MeSH terms
- Adult, Autoantibodies, Graves Disease, Humans, Male, Radiography, Receptors, Thyrotropin, Regeneration, Thymus Gland, CD4-Positive T-Lymphocytes, Autoimmunity, HIV Infections, Case-Control Studies, Ki-1 Antigen, CD8-Positive T-Lymphocytes, Lymphocyte Count, Antiretroviral Therapy, Highly Active
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