Abstract

PINTO VALDIVIA, Miguel Eduardo et al. Graves disease: report of two HIV cases of Inmune Reconstitution Syndrome following highly active antiretroviral therapy.. Rev Med Hered [online]. 2007, vol.18, n.4, pp.218-221. ISSN 1018-130X.

We report two cases of Graves’ disease after immune reconstitution following highly active antiretroviral therapy (HAART). We reviewed and abstracted the patients’ records and also conducted a review of the pertinent medical literature. Two patients with history of HIV infection developed weight loss, tachycardia, tremor, and diarrhea after 30-48 months of treatment with HAART based on zidovudine, lamivudine, and atazanavir. Their CD4 T cells count was in normal range and viral load was undetectable. Physical examination showed diffuse thyroid enlargement. Thyrotropin was suppressed, free thyroxine was elevated, and anti-TPO antibodies were positive. Both showed clinical improvement with the use methimazole and atenolol. Graves’ disease may be a form of immune reconstitution syndrome following HAART. This form of autoimmune thyroid disease is related with the second phase of T-cell repopulation with naive autoreactive CD4 T cells clones. Physicians need to be vigilant in detecting thyrotoxicosis in patients who have immune reconstituted well on HAART, since early diagnosis and treatment alleviates symptoms and may reduce long-term morbidity of Graves’ disease.

Keywords : Graves’ disease; hyperthyroidism; immune reconstitution syndrome.

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