Graves’ disease as an immune reconstitution syndrome in an HIV-1-positive patient commencing effective antiretroviral therapy: case report and literature review

Knysz, Brygida; Bolanowski, Marek; Klimczak, Malgorzata; Gladysz, Andrzej; Zwolinska, Katarzyna

doi:10.1089/vim.2006.19.102

Cited by 58Thyroid Disorders and TreatmentsHIV Research and TreatmentHIV-related health complications and treatments

Graves’ disease as an immune reconstitution syndrome in an HIV-1-positive patient commencing effective antiretroviral therapy: case report and literature review

Knysz, Brygida, Bolanowski, Marek, Klimczak, Malgorzata, Gladysz, Andrzej, Zwolinska, Katarzyna·2006·Viral Immunology

DOI 10.1089/vim.2006.19.102

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Abstract

Combination antiretroviral therapy (cART) reduces morbidity and mortality in human immunodeficiency virus (HIV) infection, but it may also alter the clinical course of subclinical opportunistic infections and can even induce autoimmune disease. These atypical presentations are known as immune restoration disease (IRD), immune reconstitution syndrome/immune recovery syndrome (IRS), or immune restoration inflammatory syndrome (IRIS). We report the case of a 27-year-old, HIV-1-positive woman who developed hyperthyroidism attributable to Graves' disease (GD) after commencing potent cART. At the initiation of cART, her CD4 T cell count was 15 cells/microL and plasma HIV RNA 35 000 copies/mL. Her commencement of cART resulted in complete viral suppression and subsequent improvement of the CD4 T-cell count. Three years later, the diagnosis of GD was established based on a typical clinical picture and the results of hormonal and immunological analyses. It coincided with a 58-fold rise of the CD4 T cells. Retrospective analysis of serum samples revealed normal thyroid function and lack of anti-thyroid peroxidase (anti-TPO), anti- thyroid-stimulating hormone receptor (anti-TSHR), and anti-thyroglobulin (anti-TG) autoantibodies at the beginning of cART. HLA class II gene examination did not reveal susceptibility for the GD development in this patient. We suggest that GD in our patient was an IRD, and advise this as a possible differential diagnosis in patients presenting with hyperthyroidism on cART. To provide further details relevant to this case, we also review the literature concerning IRD-GD.

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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 [19]

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Ludgate, S., Connolly, S. P., Fennell, D., Muhamad, M. F., Welaratne, I., Cotter, A. G., & McQuaid, S. (2021) · Endocrinology Diabetes and Metabolism Case Reports · doi:10.1530/edm-21-0094 · Cited by 9 · see citing works
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Sheikh, V., DerSimonian, R., Richterman, A. G., Porter, B. O., Natarajan, V., Burbelo, P. D., Rupert, A. W., Santich, B. H., Kardava, L., Mican, J. M., et al. (2013) · AIDS · doi:10.1097/qad.0000000000000006 · Cited by 29 · see citing works
Graves’ Disease as a Manifestation of Immune Reconstitution in HIV-Infected Individuals after Initiation of Highly Active Antiretroviral Therapy
Rasul, S., Delapenha, R., Farhat, F., Gajjala, J., & Zahra, S. M. (2011) · AIDS Research and Treatment · doi:10.1155/2011/743597 · Cited by 40 · see citing works
Graves’ Disease as a Late Manifestation of Immune Reconstitution Syndrome after Highly Active Antiretroviral Therapy in an HIV-1 Infected Patient
Mingote, E., Urrutia, A., Viteri, A., Faingold, C., & Musso, C. (2013) · World Journal of AIDS · doi:10.4236/wja.2013.33024 · Cited by 4 · see citing works
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Ayad, S., Gergis, K., Mirza, N., Rayad, M. N., & Salamera, J. (2021) · Cureus · doi:10.7759/cureus.15377 · Cited by 2 · see citing works

Authors: Knysz, B., Bolanowski, M., Klimczak, M., Gladysz, A., & Zwolinska, K.
Affiliations: Wroclaw Medical University (PL)
Department of Infectious Diseases, Wroclaw Medical University, Wroclaw, Poland.
Laboratory of Virology, Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland.
ORCID: Knysz, Brygida
Bolanowski, Marek
Venue: Viral Immunology
Publisher: SAGE Publications
Published: 2006-03
Volume: 19
Issue: 1
Pages: 102-107
ISSN: 0882-8245 (ISSN-L)
1557-8976
DOI: 10.1089/vim.2006.19.102
OpenAlex: W2013296377
Cited by: 58
References: 25
Citations by year: 2026: 1 · 2024: 1 · 2020: 3 · 2019: 2 · 2017: 1 · 2016: 2 · 2015: 3 · 2014: 4 · 2013: 10 · 2012: 4
FWCI: 3.77
Type: journal article
Language: en
Open access: closed
Licence: www.liebertpub.com/nv/resources-tools/text-and-data-mining-policy/121/ (tdm)
Locations: Viral Immunology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
Life Sciences › Immunology and Microbiology › Virology › HIV Research and Treatment
Health Sciences › Medicine › Emergency Medicine › HIV-related health complications and treatments
Keywords: Graves' disease, immune reconstitution inflammatory syndrome, HIV-1 infection, highly active antiretroviral therapy, hyperthyroidism, differential diagnosis of hyperthyroidism
MeSH terms: Adult, Drug Therapy, Combination, Female, Graves Disease, Humans, RNA, Viral, Antithyroid Agents, HIV Infections, CD4 Lymphocyte Count, Anti-HIV Agents

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Graves’ disease as an immune reconstitution syndrome in an HIV-1-positive patient commencing effective antiretroviral therapy: case report and literature review

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