Grave’s Disease as A Manifestation of Immune Reconstitution Inflammatory Syndrome (IRIS) in HIV Patients Who are Later Diagnosed with Cervical Cancer: A Case Report

Abstract

Grave’s Disease (GD) after giving Active Antiretroviral Therapy (ART) to HIV patients is one of the manifestations of Immune Reconstruction Inflammatory Syndrome (IRIS). Complaints and clinical symptoms of Grave’s IRIS usually appear in 8-33 months since the use of ART. A 40-year-old woman was diagnosed with HIV with comorbid pulmonary tuberculosis (TB) infection. The patient regularly took ART and had finished taking TB drugs for 6 months, and the pulmonary TB was declared cured. However, the patient began to complain and showed clinical symptoms of hyperthyroidism. After receiving anti-thyroid medication, the patient has no complaints related to thyroid disease. Six months later, the patient experienced frequent vaginal bleeding. After being evaluated by the Obstetrics and Gynecology section, the patient was diagnosed with cervical cancer. Abnormality of thyroid function test in HIV patients was common, but only 1-2% of HIV patients showed signs of thyroid disorder. However, few cases still show GD as a manifestation of IRIS in HIV patients receiving ART. Dysregulation of the immune system in IRIS-HIV condition and long-standing inflammatory response of HIV (innate and adaptive immune cells involvement, MCH class I & MCH class II expression, TGFβ effect, immune-modulating drugs effect, and effect of reactive oxygen species) promote progression of cancer. Keywords: Grave Disease, IRIS, Cancer, HIV