PMID- 16553555
OWN - NLM
STAT- MEDLINE
DCOM- 20060719
LR  - 20060323
IS  - 0882-8245 (Print)
IS  - 0882-8245 (Linking)
VI  - 19
IP  - 1
DP  - 2006 Spring
TI  - Graves' disease as an immune reconstitution syndrome in an HIV-1-positive patient 
      commencing effective antiretroviral therapy: case report and literature review.
PG  - 102-7
AB  - 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.
FAU - Knysz, Brygida
AU  - Knysz B
AD  - Department of Infectious Diseases, Wroclaw Medical University, Wroclaw, Poland. 
      brygida@wroclaw.dialog.net.pl
FAU - Bolanowski, Marek
AU  - Bolanowski M
FAU - Klimczak, Malgorzata
AU  - Klimczak M
FAU - Gladysz, Andrzej
AU  - Gladysz A
FAU - Zwolinska, Katarzyna
AU  - Zwolinska K
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Viral Immunol
JT  - Viral immunology
JID - 8801552
RN  - 0 (Anti-HIV Agents)
RN  - 0 (Antithyroid Agents)
RN  - 0 (RNA, Viral)
SB  - IM
MH  - Adult
MH  - Anti-HIV Agents/*therapeutic use
MH  - Antithyroid Agents/therapeutic use
MH  - CD4 Lymphocyte Count
MH  - Drug Therapy, Combination
MH  - Female
MH  - Graves Disease/*complications/drug therapy/*immunology
MH  - HIV Infections/*complications/*drug therapy
MH  - Humans
MH  - RNA, Viral/blood
RF  - 26
EDAT- 2006/03/24 09:00
MHDA- 2006/07/20 09:00
CRDT- 2006/03/24 09:00
PHST- 2006/03/24 09:00 [pubmed]
PHST- 2006/07/20 09:00 [medline]
PHST- 2006/03/24 09:00 [entrez]
AID - 10.1089/vim.2006.19.102 [doi]
PST - ppublish
SO  - Viral Immunol. 2006 Spring;19(1):102-7. doi: 10.1089/vim.2006.19.102.