++
++
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.
++
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.
+++
Alterations in Thyroid Function Tests
++
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), ...