[HIV-therapy-associated immune reconstitution syndrome presenting as immunogenic hyperthyroidism]

Area of Science:

• Immunology
• Endocrinology
• Infectious Diseases

Background:

• Antiretroviral therapy (ART) for HIV-1 infection can lead to immune reconstitution inflammatory syndrome (IRIS).
• IRIS typically manifests as an exaggerated inflammatory response to opportunistic infections or self-antigens.
• Delayed onset of IRIS, particularly with autoimmune manifestations, is less commonly reported.

Observation:

• A 51-year-old male with HIV-1 developed weight loss, fever, and tremor three years post-ART initiation.
• Investigations revealed hyperthyroidism, elevated thyroid autoantibodies, and abnormal alpha-fodrin and antinuclear antibodies.
• Electrocardiogram showed atrial fibrillation, consistent with hyperthyroidism.

Findings:

• The patient was diagnosed with Graves' disease presenting as IRIS.
• Treatment with radioiodide led to clinical euthyroidism while ART was continued.
• This case demonstrates a delayed autoimmune IRIS presentation years after effective HIV-1 treatment.

Implications:

• IRIS can present with autoimmune manifestations, such as Graves' disease, even years after initiating ART.
• Understanding the mechanisms of delayed autoimmune IRIS is crucial for managing HIV-1 patients.
• This case underscores the importance of considering autoimmune conditions in HIV-1 patients experiencing inflammatory symptoms despite effective viral suppression.