Sequential occurrence of thyroid autoantibodies and Graves' disease after immune restoration in severely immunocompromised human immunodeficiency virus-1-infected patients

We analyzed the kinetics of CD4 cells, human immunodeficiency virus (HIV) v iral load, and autoantibodies in acquired immune deficiency syndrome patien ts with Graves' disease (GD) after immune restoration on highly active anti retroviral therapy (HAART; retrospective study). Five patients (median age, 41 yr) were diagnosed with GD after 20 (range, 1 4-22) months on HAART on the basis of clinical and biological hyperthyroidi sm, diffuse hyperfixation of thyroid scan, and the presence of anti-TSH rec eptor (anti-TSHR) antibodies (Ab). GD was diagnosed several months after th e plasma HIV ribonucleic acid load became undetectable, when the CD4(+) cel l count had risen from 14 (range, 0-62) to 340 (range, 163-460) x 10(6) cel ls/L. Antithyroid peroxidase (anti-TPO) and anti-TSHRAb appeared 14 (range, 9-18) and 14 (range, 11-20) months after starting HAART and 12 (range, 6-1 5) and 11 (range, 9-17) months after the increase in CD4(+) cells. In 3 pat ients, TPOAb preceded TSHRAb by 3-10 months. No other autoantibodies were d etected. Thyroid antibodies were absent in a group of 55 HIV-1-positive pat ients with comparable response to HAART and no symptoms of hyperthyroidism (cross-sectional study). Thyroid-specific autoimmunity can occur upon immune restoration with HAART. Our observations suggest a relationship between thymus-dependent immune re constitution after immunosuppression and autoimmunity and may provide insig ht into the pathophysiology of GD.