Narrative Review on Parathyroid Gland Disorders in Individuals Living with HIV: An Update

Area of Science:

• Endocrinology
• Infectious Diseases
• Bone Metabolism

Background:

• Parathyroid gland disorders are significant endocrine complications in people living with HIV (PLWHIV).
• HIV infection, combined antiretroviral therapy (cART), and immune activation contribute to parathyroid dysfunction.
• Tenofovir Disoproxil Fumarate (TDF) regimens can exacerbate these disturbances by altering calcium and parathyroid hormone (PTH) dynamics.

Purpose of the Study:

• To synthesize recent evidence on the prevalence, mechanisms, and clinical implications of parathyroid dysfunction in PLWHIV.
• To highlight the impact of cART, particularly TDF, on parathyroid hormone levels and calcium metabolism.
• To advocate for improved screening and monitoring of parathyroid function and bone health in PLWHIV.

Main Methods:

• Narrative review of recent scientific evidence.
• Analysis of studies on PTH levels in PLWHIV on different cART regimens.
• Examination of histopathological findings related to parathyroid hyperplasia in PLWHIV.

Main Results:

• PLWHIV on TDF-based cART show significantly elevated PTH levels compared to those on non-TDF regimens.
• Higher prevalence of parathyroid hyperplasia linked to deficiencies in calcium, magnesium, vitamin D, and immune dysregulation.
• Parathyroid dysfunction ranges from elevated PTH to hypoparathyroidism, increasing fracture risk.

Conclusions:

• Routine screening for PTH, calcium, phosphate, and vitamin D is recommended, especially for those on TDF-based cART.
• Early detection of subclinical parathyroid dysfunction can prevent secondary hyperparathyroidism and neuromuscular symptoms.
• Clinicians must recognize atypical biochemical presentations, such as elevated PTH with normal calcium, indicating cART-induced dysregulation.