Characteristics of Graves disease in HIV-infected patients on antiretroviral therapy

Copyright © 2020 AACE. Objective: To demonstrate clinical and laboratory characteristics of Graves disease in human immunodeficiency virus (HIV)-infected patients on antiretroviral therapy (ART). Methods: This is a single-institution study. All HIV-infected Thai patients who were diagnosed with Grav...

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Main Authors: Vitvala Jariyawattanarat, Somnuek Sungkanuparph, Chutintorn Sriphrapradang
Other Authors: Faculty of Medicine, Ramathibodi Hospital, Mahidol University
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Published: 2020
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Online Access:https://repository.li.mahidol.ac.th/handle/123456789/57719
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spelling th-mahidol.577192020-08-25T17:37:25Z Characteristics of Graves disease in HIV-infected patients on antiretroviral therapy Vitvala Jariyawattanarat Somnuek Sungkanuparph Chutintorn Sriphrapradang Faculty of Medicine, Ramathibodi Hospital, Mahidol University Mahidol University Biochemistry, Genetics and Molecular Biology Medicine Copyright © 2020 AACE. Objective: To demonstrate clinical and laboratory characteristics of Graves disease in human immunodeficiency virus (HIV)-infected patients on antiretroviral therapy (ART). Methods: This is a single-institution study. All HIV-infected Thai patients who were diagnosed with Graves disease following the initiation of ART between January, 2007, and June, 2018, were retrospectively enrolled. Results: Of the 24 subjects, the mean age was 39.6 ± 10 years at the time of Graves disease diagnosis. The male to female ratio was 1:1.2. Palpitation and weight loss were the most common clinical manifestations. Of the 6 patients (25%) with evidence of Graves orbitopathy, 1 had sight-threatening orbitopathy. Two patients also had other autoimmune diseases (vitiligo and psoriatic arthritis). The median CD4 cell counts at HIV and Graves disease diagnosis were 73.5 (interquartile range [IQR], 15.5 to 189.5) and 525 (IQR, 402.3 to 725) cells/µL, respectively. The median time from ART commencement of the last effective ART regimen to the development of Graves disease was 29.5 (IQR, 13.8 to 48) months with a mean CD4 cell count increment of 328.7 ± 174.9 cells/µL. The median duration of antithyroid therapy was 34.5 (IQR, 23.8 to 51.0) months. Thirteen patients (54.2%) received radioactive iodine ablation. Conclusion: Graves disease should be suspected in HIV-infected patients who present with palpitations and weight loss despite good immunologic response to ART. Awareness of this condition can lead to diagnosis and appropriate management. Unlike immune reconstitution disease associated with infection, Graves disease may develop many years after ART initiation. 2020-08-25T09:04:57Z 2020-08-25T09:04:57Z 2020-06-01 Article Endocrine Practice. Vol.26, No.6 (2020), 612-618 10.4158/EP-2019-0514 19342403 1530891X 2-s2.0-85086884524 https://repository.li.mahidol.ac.th/handle/123456789/57719 Mahidol University SCOPUS https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85086884524&origin=inward
institution Mahidol University
building Mahidol University Library
continent Asia
country Thailand
Thailand
content_provider Mahidol University Library
collection Mahidol University Institutional Repository
topic Biochemistry, Genetics and Molecular Biology
Medicine
spellingShingle Biochemistry, Genetics and Molecular Biology
Medicine
Vitvala Jariyawattanarat
Somnuek Sungkanuparph
Chutintorn Sriphrapradang
Characteristics of Graves disease in HIV-infected patients on antiretroviral therapy
description Copyright © 2020 AACE. Objective: To demonstrate clinical and laboratory characteristics of Graves disease in human immunodeficiency virus (HIV)-infected patients on antiretroviral therapy (ART). Methods: This is a single-institution study. All HIV-infected Thai patients who were diagnosed with Graves disease following the initiation of ART between January, 2007, and June, 2018, were retrospectively enrolled. Results: Of the 24 subjects, the mean age was 39.6 ± 10 years at the time of Graves disease diagnosis. The male to female ratio was 1:1.2. Palpitation and weight loss were the most common clinical manifestations. Of the 6 patients (25%) with evidence of Graves orbitopathy, 1 had sight-threatening orbitopathy. Two patients also had other autoimmune diseases (vitiligo and psoriatic arthritis). The median CD4 cell counts at HIV and Graves disease diagnosis were 73.5 (interquartile range [IQR], 15.5 to 189.5) and 525 (IQR, 402.3 to 725) cells/µL, respectively. The median time from ART commencement of the last effective ART regimen to the development of Graves disease was 29.5 (IQR, 13.8 to 48) months with a mean CD4 cell count increment of 328.7 ± 174.9 cells/µL. The median duration of antithyroid therapy was 34.5 (IQR, 23.8 to 51.0) months. Thirteen patients (54.2%) received radioactive iodine ablation. Conclusion: Graves disease should be suspected in HIV-infected patients who present with palpitations and weight loss despite good immunologic response to ART. Awareness of this condition can lead to diagnosis and appropriate management. Unlike immune reconstitution disease associated with infection, Graves disease may develop many years after ART initiation.
author2 Faculty of Medicine, Ramathibodi Hospital, Mahidol University
author_facet Faculty of Medicine, Ramathibodi Hospital, Mahidol University
Vitvala Jariyawattanarat
Somnuek Sungkanuparph
Chutintorn Sriphrapradang
format Article
author Vitvala Jariyawattanarat
Somnuek Sungkanuparph
Chutintorn Sriphrapradang
author_sort Vitvala Jariyawattanarat
title Characteristics of Graves disease in HIV-infected patients on antiretroviral therapy
title_short Characteristics of Graves disease in HIV-infected patients on antiretroviral therapy
title_full Characteristics of Graves disease in HIV-infected patients on antiretroviral therapy
title_fullStr Characteristics of Graves disease in HIV-infected patients on antiretroviral therapy
title_full_unstemmed Characteristics of Graves disease in HIV-infected patients on antiretroviral therapy
title_sort characteristics of graves disease in hiv-infected patients on antiretroviral therapy
publishDate 2020
url https://repository.li.mahidol.ac.th/handle/123456789/57719
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