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JAC Advance Access published online on September 1, 2006
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkl360
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Received May 3, 2006
Revised August 4, 2006
Accepted August 10, 2006

Brief report

Subclinical hypothyroidism in HIV-infected subjects

Marco Bongiovanni 1 *, Fulvio Adorni 2, Maddalena Casana 1, Federica Tordato 1, Camilla Tincati 1, Paola Cicconi 1, Teresa Bini 1, and Antonella d'Arminio Monforte 1

1 Clinic of Infectious Diseases, San Paolo Hospital, University of Milan, Milan, Italy
2 National Research Council, Milan, Italy

* To whom correspondence should be addressed.
Marco Bongiovanni, E-mail: marco.bongiovanni{at}unimi.it


  Abstract

Objectives: The correlation between subclinical hypothyroidism [thyroid stimulating hormone (TSH) >4 mIU/L with normal free triiodothyroxine and free thyroxine levels], HIV infection and HAART is still unclear.

Patients and methods: To evaluate the predictive factors of subclinical hypothyroidism in an HIV-infected population, we identified three groups of subjects: G1, subjects on stable highly active antiretroviral therapy (HAART) (for at least 1 year) at baseline and at month 24 (n = 97); G2, subjects naive at both baseline and month 24 (n = 47); G3, subjects starting HAART at baseline (n = 46).

Results: The three groups were comparable with respect to age, gender, body weight and prevalence of HCV infection. At baseline, subclinical hypothyroidism was detected in 14 subjects in G1 (14.4%), 5 in G2 (10.6%) and 4 in G3 (8.7%) (P = 0.18) and these were excluded from the analysis. At month 24, 15 subjects had developed subclinical hypothyroidism: 4 in G1 (4.8%), 3 in G2 (7.1%) and 8 in G3 (19.0%). In the multivariable analysis, the higher increase in total cholesterol was predictive of subclinical hypothyroidism (RR: 1.53 for each additional 10 mg/dL, 95% CI 1.23-1.90; P < 0.01); other variables, which were statistically significant in the univariate analysis, such as G3 group, body weight and higher increase in CD4+ cell count and in triglyceride serum levels were not confirmed to be associated with TSH alterations.

Conclusions: The occurrence of subclinical hypothyroidism in HIV-positive patients seems to be related to the increase in total cholesterol serum levels occurring after HAART initiation. Thyroid function should be monitored in all HIV-infected subjects, especially in those starting HAART.

Keywords: thyroid; HAART; HIV.
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