Study of Thyroid Function in Newly Diagnosed Human Immunodeficiency Virus Patients and Effect of Antiretroviral...

Thyroid dysfunction is a frequently overlooked yet clinically significant comorbidity in human immunodeficiency virus (HIV)-infected individuals. The introduction of antiretroviral therapy (ART) has improved life expectancy but has also been associated with metabolic and endocrine disturbances, including thyroid abnormalities. Thyroid dysfunctions such as subclinical hypothyroidism, sick euthyroid syndrome, and overt hypothyroidism are increasingly recognized in both treatment-naïve and ART-experienced patients. However, limited data are available on thyroid function at the time of HIV diagnosis and its evolution following ART initiation, especially in the Indian population.

This prospective observational study was conducted at Moti Lal Nehru Medical College, Prayagraj, including 100 newly diagnosed HIV patients aged ≥18 years. Baseline free T3, free T4, TSH, and CD4 were measured prior and 3 months after the start of ART. Statistical analysis was performed using SPSS version 27.0, with paired t-tests, analysis of variance (ANOVA), and Pearson correlation test to assess the changes and associations between thyroid parameters and ART, CD4 count, and demographic variables.

The study focused on measuring serum free T3, free T4, and TSH levels at baseline and after ART initiation and analyzing their relationship with immunological status as indicated by CD4 count. The study population consisted of 100 individuals with a mean age of 37.29 ± 13.01 years, predominantly male (70%). At baseline, 62% of patients were euthyroid, while the remaining 38% showed thyroid dysfunction, primarily subclinical hypothyroidism and subclinical hyperthyroidism. Following 3 months of ART, the prevalence of thyroid dysfunction increased: euthyroid patients decreased to 41%, and cases of subclinical hypothyroidism, clinical hypothyroidism, and subclinical hyperthyroidism rose noticeably. This shift in thyroid status distribution was statistically significant (Chi-squared test, p = 0.028), suggesting a potential impact of ART on thyroid physiology. In terms of hormone levels, the study observed a statistically significant increase in mean TSH values (from 4.23 ± 4.13 µIU/mL to 7.50 ± 7.85 µIU/mL, p < 0.001) and a significant decrease in free T3 levels (from 2.92 ± 0.88 pg/mL to 2.45 ± 1.00 pg/mL, p = 0.005) post-ART. Free T4 levels did not show a significant change (p = 0.337). These results align with existing literature suggesting that ART may unmask or exacerbate subclinical thyroid dysfunction, possibly through immune reconstitution or direct effects on thyroid metabolism. Correlation analysis demonstrated a significant negative association between CD4 count and TSH levels both before and after ART (ρ = -0.28 and -0.34, respectively), and a positive correlation between CD4 and both free T3 and free T4.

This study establishes that ART is associated with significant changes in thyroid hormone profiles, particularly an increase in TSH and a decline in free T3 levels, reflecting emerging thyroid dysfunction. The results underscore the importance of regular thyroid function monitoring in HIV patients, particularly after initiating ART, to facilitate early detection and management of evolving endocrine disturbances.