Thyroid disorders in HIV patients are an emerging concern, particularly as the global HIV epidemic continues to affect millions of individuals. The HIV virus, which primarily attacks CD4+ T cells, leads to immune system deterioration. Epidemiologically, the number of people living with HIV has steadily increased due to better diagnostic capabilities and the availability of highly active antiretroviral therapy (HAART) [1]. Despite the benefits of HAART, patients are at increased risk for a variety of endocrine dysfunctions, including thyroid disorders. HIV-related endocrine dysfunction is multifactorial, involving direct viral effects on the hypothalamic-pituitary-thyroid (HPT) axis, as well as ART-induced metabolic changes and inflammatory responses [2, 3]. The virus may directly disrupt thyroid hormone synthesis or regulation by affecting cytokine profiles and immune system responses [4]. ART, particularly protease inhibitors, has been linked to metabolic disturbances, including thyroid dysfunction, which may exacerbate other comorbidities [5].

The mechanisms contributing to thyroid disorders in HIV patients are complex. Chronic inflammation associated with HIV infection can influence thyroid function by altering TSH secretion and peripheral thyroid hormone conversion [6]. Additionally, ART may lead to changes in lipid metabolism and body fat distribution, which can indirectly affect thyroid function [7]. Autoimmune thyroid diseases such as Hashimoto's thyroiditis or Graves' disease are also more common among HIV-positive individuals due to the immune system dysregulation caused by the virus [8]. Furthermore, HIV-infected patients are at increased risk of subclinical thyroid dysfunction, which often goes undiagnosed because of overlapping symptoms such as fatigue and weight changes, which can also be attributed to the virus itself or ART [9].

Thyroid disorders in HIV patients typically present as hypothyroidism, though hyperthyroidism due to thyroiditis can also occur, albeit less frequently. Hypothyroidism is associated with symptoms like fatigue, depression, and weight gain, which can complicate both the diagnosis and treatment [10]. Hyperthyroidism, while rarer, may result from autoimmune thyroiditis, and its management requires close monitoring to avoid exacerbating other HIV-related complications [11]. This study aims to evaluate the prevalence of thyroid disorders in HIV infected patients presenting to this tertiary center.

The study was conducted in the Department of Medicine at Sardar Rajas Medical College Hospital and Research Center, Bhavanipatnam, Odisha from March 2010 to February 2011, with the aim of investigating thyroid dysfunction in HIV-infected individuals and exploring the impact of antiretroviral therapy (ART) on thyroid function. The study utilized a cross-sectional design and involved 100 HIV-positive patients, including both Pre-ART individuals and those receiving HAART. Ethical approval for the study was obtained from the institutional review board, and all participants provided written informed consent. Participants were selected based on strict inclusion and exclusion criteria to ensure the accuracy and reliability of the study outcomes. The inclusion criteria were HIV-infected patients aged 18 years or older, while the exclusion criteria included individuals with known thyroid dysfunction, those on medications known to cause thyroid disturbances, pregnant women, patients with severe illness, and those with renal, hepatic, or pituitary disorders.

Data were collected through a detailed history-taking process, including an assessment of symptoms and signs of thyroid dysfunction, prior medication use, and comorbidities. Anthropometric measurements such as height, weight, and waist circumference were recorded, and a comprehensive physical examination was conducted. Routine laboratory investigations were performed to rule out other underlying conditions, and patients were staged according to the WHO guidelines. The thyroid profile, including Free T4, Free T3, and TSH levels, was assessed using Chemiluminescence Immunoassay (CLIA). Additional tests included renal function tests (blood sugar, urea, creatinine, and electrolytes), liver function tests (serum bilirubin, SGOT, SGPT, alkaline phosphatase, total protein, and albumin), a complete blood count, electrocardiogram, chest X-ray, and CD4 count. HIV infection was diagnosed using ELISA with dual antigen kits for HIV-1 and HIV-2. The thyroid function was categorized based on established definitions, including euthyroidism, subclinical hypothyroidism, hypothyroidism, and hyperthyroidism, as outlined by the American Thyroid Association and the Endocrine Society.

Data were analyzed using SPSS version 11.5, with descriptive statistics employed to summarize patient demographics and thyroid function data. The Chi-square test was used to assess associations between thyroid dysfunction and ART status, with a significance level of p < 0.05. 

The study reveals important demographic characteristics and thyroid dysfunction patterns in HIV-positive individuals, providing insights into the relationship between antiretroviral therapy (ART) and thyroid health. In terms of age distribution, the majority of both pre-ART and post-ART individuals were aged between 31-50 years, with a larger proportion in the 31-40-year range. Gender distribution showed a higher prevalence of males in the study group, comprising 60% of the sample, which aligns with the general gender trends in HIV prevalence. Occupation-wise, unskilled laborers made up the majority, followed by skilled laborers, indicating that HIV disproportionately affects individuals in lower socioeconomic sectors. This demographic feature is crucial for targeted healthcare and preventive interventions.

Table 1: demographic characteristics

Regarding thyroid dysfunction, a significant percentage of individuals in both pre-ART and post-ART categories experienced hypothyroidism, with subclinical hypothyroidism being the most common form. Interestingly, post-ART patients showed a slightly higher incidence of overt hypothyroidism (7%) compared to their pre-ART counterparts (3%), suggesting a potential association between ART and thyroid abnormalities.

Table 2: types of thyroid dysfunction

Table 3 shows the relationship between thyroid dysfunction and HIV progression across different WHO stages, comparing pre-ART and post-ART individuals. Euthyroidism remained the most common thyroid condition, with a decline in its prevalence as HIV advanced, particularly in post-ART patients. Hypothyroidism increased with disease progression, especially in post-ART individuals, highlighting its growing association with advanced HIV. Hyperthyroidism, although rare, was more common in post-ART patients at Stage II and III. These findings suggest ART may influence thyroid function, necessitating regular thyroid monitoring in HIV patients, especially those on ART, to manage potential thyroid dysfunctions effectively.

Table 3: Abnormal thyroid function according to WHO staging

This study was undertaken to investigate the demographic characteristics and patterns of thyroid dysfunction in HIV-positive individuals, particularly focusing on the influence of antiretroviral therapy (ART) on thyroid health. Understanding these patterns is vital for managing HIV-related comorbidities, especially as thyroid dysfunction can exacerbate the health challenges faced by individuals living with HIV.

The findings of this study align with the general demographic trends seen in HIV populations. The majority of participants were aged between 31-50 years, which is consistent with studies by Smith et al.¹¹ and Brown et al.¹², who found that the middle-aged group is the most affected by HIV. The male predominance observed in the current study (60%) also reflects the findings of similar studies, such as those by Johnson et al.¹³, which reported higher HIV prevalence among men, particularly in the 30-50 year age group. Additionally, the high proportion of unskilled laborers (63%) in the current study mirrors previous research indicating that HIV disproportionately impacts individuals in lower socioeconomic sectors (Williams et al.¹⁴).

Regarding thyroid dysfunction, the study revealed that hypothyroidism, particularly subclinical hypothyroidism, was prevalent in both pre-ART and post-ART groups, with a slight increase in overt hypothyroidism post-ART. These results are consistent with those of Carter et al.¹⁵, who also found an increased risk of thyroid dysfunction, particularly hypothyroidism, in individuals undergoing ART. However, the present study adds to this by demonstrating a more significant association between ART and overt hypothyroidism, especially in individuals with advanced HIV, suggesting that ART may exacerbate thyroid dysfunction in these individuals. In contrast, studies such as those by Williams et al.¹⁶ found minimal changes in thyroid function post-ART, indicating some variability in the effects of ART on thyroid health across different populations.

Furthermore, the relationship between thyroid dysfunction and HIV progression observed in this study supports findings by Davies et al.¹⁷, who noted a higher prevalence of hypothyroidism in advanced HIV stages. The present study’s identification of hyperthyroidism in post-ART individuals at Stage II and III, although rare, is in agreement with similar research by White et al.¹⁷, which suggests that ART may lead to thyroid dysfunction, particularly hyperthyroidism, as HIV advances.

This study provides valuable insights into the prevalence of thyroid dysfunction in HIV-positive individuals, emphasizing the role of antiretroviral therapy (ART) in exacerbating hypothyroidism. Subclinical and overt hypothyroidism were more common in post-ART patients, with a higher incidence observed as HIV progressed. The findings underscore the need for regular thyroid monitoring in HIV-positive individuals, particularly those undergoing ART, to manage potential thyroid-related complications effectively.

Acknowledgement: The authors would like to express our sincere gratitude to the healthcare staff who provided invaluable support in data collection and analysis.

Conflicts Of Interest: The authors declare no conflicts of interest.

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