Graves Disease in Hiv-Infected Patients

Abstract

Jariyawattanarat and colleagues ( 1. Jariyawattanarat V. Sungkanuparph S. Sriphrapradang C. Characteristics of Graves’ disease in HIV-infected patients on anti-retroviral therapy. Endocr Pract. 2020; 26: 612-618 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar ) present an intriguing retrospective analysis of Graves disease in patients with human immunodeficiency virus (HIV) on antiretroviral therapy (ART). They describe this as “HIV-associated Graves disease” and draw conclusions about the presentation of Graves in these patients versus non–HIV-infected patients. Given that Graves is the most common cause of hyperthyroidism, I am curious how the authors distinguished Graves as part of an immune reconstitution phenomenon from coincidental new-onset Graves that may have occurred independent of HIV status, particularly given how much later median onset time was (29.5 months) compared to prior studies of this phenomenon ( 2. Jubault V. Penfornis A. Schillo F. Sequential occurrence of thyroid autoantibodies and Graves’ disease after immune restoration in severely immunocompromised human immunodeficiency virus-1–infected patients. J Clin Endocrinol Metab. 2000; 85: 4254-4257 Crossref PubMed Scopus (117) Google Scholar , 3. Chen F. Day S.L. Metcalfe R.A. Characteristics of autoimmune thyroid disease occurring as a late complication of immune reconstitution in patients with advanced human immunodeficiency virus (HIV) disease. Medicine (Baltimore). 2005; 84: 98-106 Crossref PubMed Scopus (106) Google Scholar ). Sex distribution, as cited by the authors, may not be definitive for this. It is notable that the standard deviation of last effective ART to Graves diagnosis was quite large at 23 months, reflected in Figure 1 below. Could this suggest that at least some of the Graves diagnoses were unrelated to ART/HIV, therefore compromising the generalizability of conclusions related to Graves presentation in HIV-infected versus non–HIV-infected individuals?