Dysthyroidism among HIV/Aids Patients on Antiretroviral therapy
Thaimuta, Zakayo L
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BACKGROUND: The availability of potent combination of antiretroviral regimes has resulted in a dramatic reduction of HIV-l associated morbidity and mortality. The optimism generated by such treatment has been diminished by recognition of a high array of adverse events. Several cases of thyroid dysfunction have been reported in association with HIV infection before the introduction of highly active antiretroviral therapy. Prolonged antiretroviral therapy has been associated with adverse events such as Grave's disease, sub-clinical hypothyroidism, and sick euthyroidism. It is important to find out whether these events are observed in HIV infected patients on long term treatment of stavudine, lamivudine, and nevi rapine, the first line ARV protocol in Kenya. OBJECTIVES: This study had a broad objective of assessing the thyroid dysfunction among HIV/AlDS patients receiving antiretroviral drugs: stavudine, lamivudine, and nevirapine (HAART). The specific objectives of this study were to: determine thyroid function in HIV positive patients taking antiretroviral drugs; determine the prevalence of dysthyroidism in HIV/AIDS patients on ARV; correlate levels ofCD4 T cell count with duration of treatment; and determine thyroid peroxidase antibodies presence as an indicator of autoimmune thyroid disease. METHODOLOGY: The study recruited 84 HlV-infected patients on treatment of ARVs (ARV +ve) and an ARV naive group of26 HIV: infected patients as a comparative group. Thyroid function tests (TSH, FT4, T4, T3 and FT3), and thyroid peroxidase antibodies (TPOAb) were assessed using the technique of enzyme linked immunosorbent antibody (ELISA). The data was analyzed using SPSS 12.0.1 version. RESULTS: Dysthyroidism was common in HIV-infected patients. Sick euthyroid syndrome was found to be 44% among ARV +ve patients and 46%- among ARV nalve (p = 0.06) overall. This condition reduced with the duration of ARV treatment. This was reflected in increasing levels of FT4 (p value <O.OS}.Sub-clinical hypothyroidism was found only among the ARV+ve (4.8%) and was absent in ARV naive group (0010) with a p value of 0.008. The prevalence of thyroid peroxidase antibodies was 2.4% in ARV +ve and 15.4% in ARV naive with p value of O.028.-c64 T Iymphocyte count increased as treatment progressed (p = 0.013). CONCLUSION: Sick euthyroid syndrome has a high prevalent among HlV patients either in ARV or not but it decreased with duration of treatment in AR V +ve group. Sub-clinical hypothyroidism is a condition that might develop during treatment as seen in this study where the prevalence 4.8%. CD4 T lymphocyte count increased with antiretroviral therapy. Thyroid peroxidase antibodies have a high prevalence in HIV positive patients before treatment compared to ARV naive group.