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INTRODUCTION

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ACTH Adrenocorticotropic hormone
AIDS Acquired immunodeficiency syndrome
BMD Bone mineral density
CMV Cytomegalovirus
CRH Corticotropin-releasing hormone
CVD Cardiovascular disease
DHEA Dehydroepiandrosterone
DXA Dual energy x-ray absorptiometry
FSH Follicle-stimulating hormone
GH Growth hormone
GHRH Growth hormone-releasing hormone
GnRH Gonadotropin-releasing hormone
HAART Highly active antiretroviral therapy
HDL High-density lipoprotein
HIV Human immunodeficiency virus
IGF Insulin-like growth factor
IL Interleukin
IMT Intima media thickness
LDL Low-density lipoprotein
LH Luteinizing hormone
M/I Glucose disposal adjusted for insulin level
MRI Magnetic resonance imaging
NRTI Nucleoside reverse transcriptase inhibitor
NNRTI Non-nucleoside reverse transcriptase inhibitor
PI Protease inhibitor
PPARf Peroxisome proliferator-activated receptor γ
PTH Parathyroid hormone
RANK Receptor activator of nuclear factor kappa
REE Resting energy expenditure
RXR Retinoid X receptor
SAT Subcutaneous adipose tissue
SREBP1 Sterol regulatory enhancer-binding protein 1
T3 Triiodothyronine
T4 Thyroxine
TBG Thyroxine-binding globulin
TNF Tumor necrosis factor
TRH Thyrotropin-releasing hormone
VAT Visceral adipose tissue
VLDL Very low density lipoprotein

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Symptoms consistent with endocrine disorders and alterations in endocrine laboratory values are not unusual in individuals infected with the human immunodeficiency virus (HIV). Some of these changes are common to any significant systemic illness; others appear to be more specific to HIV infection or its therapies. Alterations can be found even before clinically significant immunocompromise occurs. As the infected individual becomes immunocompromised, particularly with development of the acquired immunodeficiency syndrome (AIDS), opportunistic infections and neoplasms—as well as the agents used in the treatment of these disorders—can give rise to further changes in endocrine function. Finally, hepatitis C (HCV) coinfection occurs in approximately 1/3 of HIV-infected patients; HCV also induces changes. Herein we discuss alterations in endocrine function that can accompany HIV/AIDS, focusing on evaluation and interpretation of clinical and laboratory findings.

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THYROID DISORDERS

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In the era of highly active antiretroviral therapy (HAART), clinical thyroid dysfunction is relatively uncommon in stable HIV-infected patients. In several large studies, the prevalence of hypothyroidism was 1% to 2.5% and hyperthyroidism was 0.5% to 1%. The prevalence of subclinical disease was higher, with subclinical hypothyroidism between 3.5% and 20% and subclinical hyperthyroidism less than 1%; definitions varied between studies. These data do not support screening for thyroid disease above standard guidelines. With advanced HIV disease, alterations in thyroid function tests do occur, but generally do not result in clinical dysfunction. In patients with AIDS, the effects of opportunistic infections and neoplastic involvement of the thyroid, as well as the effects of some medications used to treat HIV-infected patients, should be considered.

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Alterations in Thyroid Function Tests

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HIV-infected patients can show alterations in thyroid function tests that are largely asymptomatic. Some of the changes are similar to those seen in the classic euthyroid sick syndrome, whereas others are unique to HIV. Advanced HIV is associated with decrease in thyroid hormone levels, triiodothyronine (T3) and thyroxine (T4), similar ...

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