A Contemporary Multifaceted Narrative Review on Thyroid Dysfunction in People Living with Human Immunodeficiency...

Area of Science:

• Endocrinology
• Infectious Diseases
• Public Health

Background:

• Combined antiretroviral therapy (cART) has improved life expectancy for people living with HIV (PLWH).
• Increased surveillance in HIV clinics reveals a rising incidence of thyroid dysfunction among PLWH.
• Thyroid dysfunction is a significant comorbidity in the PLWH population.

Purpose of the Study:

• To review the literature on thyroid dysfunction in people living with HIV.
• To identify the prevalence and types of thyroid dysfunction in PLWH.
• To discuss the relationship between cART, immune reconstitution, and thyroid disorders.

Main Methods:

• A narrative review of primary studies, case reports, and meta-analyses.
• Literature search conducted on PubMed, Embase, and Cochrane databases.
• Analysis of reported thyroid dysfunction prevalence and associated factors in PLWH.

Main Results:

• Subclinical hypothyroidism (SCH) is the most prevalent thyroid dysfunction, affecting up to 40% of PLWH with severe immunosuppression (CD4 T-cell count < 350 cells/mm³).
• Overt hyperthyroidism and thyroid malignancy are less common but reported.
• cART initiation and immune reconstitution inflammatory syndrome (IRIS) are linked to thyroid dysfunction, including Grave's disease.

Conclusions:

• PLWH on cART are at increased risk for thyroid dysfunction, notably SCH.
• Monitoring for thyroid dysfunction, including Grave's disease and malignancy, is crucial, especially during immune reconstitution.
• Recommended screening includes FT4, FT3, TSH, thyroid antibodies, and vigilance for symptoms, particularly in patients with comorbidities or significant immune changes.