Immune reconstitution inflammatory syndrome‐associated Graves disease in HIV‐infected patients: clinical characteristics and response to radioactive iodine therapy

• Published in: HIV medicine 2021-11, Vol.22 (10), p.907-916
• Main Authors: Lawal, Ismaheel O., Orunmuyi, Akintunde T., Popoola, Gbenga O., Mokoala, Kgomotso M. G., Lengana, TThabo, Sathekge, Mike M.
• Format: Article
• Language: English
• Subjects: CD4 antigen; Graves disease; Graves Disease - complications; Graves Disease - drug therapy; Graves Disease - radiotherapy; Health services; HIV; HIV Infections - complications; HIV Infections - drug therapy; Human immunodeficiency virus; Humans; Hypothyroidism; Immune reconstitution; immune reconstitution inflammatory syndrome; Immune Reconstitution Inflammatory Syndrome - etiology; Iodine; Iodine radioisotopes; Iodine Radioisotopes - therapeutic use; Medical records; Patients; Peak load; radioactive iodine treatment; Retrospective Studies; Thyroid; Thyroid Neoplasms - chemically induced; Thyroid Neoplasms - complications; Thyroid Neoplasms - drug therapy; Viremia
• ISSN: 1464-2662; 1468-1293
• DOI: 10.1111/hiv.13148

Objectives We aimed to describe the clinical characteristics and the response to radioactive iodine (RAI) treatment of immune reconstitution inflammatory syndrome‐associated Graves disease (IRIS‐GD) in comparison to Graves disease (GD) seen in HIV‐uninfected patients. Methods We retrospectively reviewed the medical records of patients treated with RAI for GD. We obtained clinical, biochemical and HIV‐related information of patients from their medical records. We compared patient characteristics and response to RAI treatment between patients with IRIS‐GD and GD seen in HIV‐uninfected patients. Results A total of 253 GD patients, including 51 patients with IRIS‐GD, were included. Among IRIS‐GD patients, CD4 cell nadir was 66 cells/µL (range: 37–103) with a peak HIV viral load of 60 900 copies/mL (range: 36 542–64 500). At the time of diagnosis of IRIS‐GD, all patients had a completely suppressed HIV viraemia with a CD4 cell count of 729 cells/µL (range: 350–1279). The median interval between the commencement of HIV treatment and the onset of GD was 63 months. At 3 months follow‐up, the proportion of patients with IRIS‐GD achieving a successful RAI treatment outcome (euthyroid/hypothyroid state) was lower than that of HIV‐uninfected patients (35.3% vs. 63.4%, respectively; p