Prevalence and determinants of thyroid dysfunction in human immunodeficiency virus-infected patients: Role of CD4 count and antiretroviral therapy duration
Rahul Garg, Prashant PrakashObjectives:
Thyroid dysfunction is increasingly recognized as a significant comorbidity in people living with human immunodeficiency virus (PLHIV). This cross-sectional observational study aimed to determine the prevalence of various types of thyroid dysfunction in human immunodeficiency virus (HIV) -positive patients and explore their associations with CD4+ counts and antiretroviral therapy (ART).
Material and Methods:
This cross-sectional observational study included 81 HIV-positive patients attending a tertiary care center in Uttar Pradesh, India. Thyroid function tests (TSH, free T3, free T4) were performed and analyzed in relation to CD4+ counts, ART regimens, and other clinical parameters.
Results:
The overall prevalence of thyroid dysfunction was 32.1% (26/81; 95% CI: 22.4–43.4%), with subclinical hypothyroidism being the most common abnormality (18.5%, n = 15), followed by overt hypothyroidism (7.4%, n = 6), subclinical hyperthyroidism (3.7%, n = 3), and overt hyperthyroidism (2.5%, n = 2). A significant inverse correlation was observed between CD4+ count and TSH levels ( r = −0.43, p <0.001). Thyroid dysfunction prevalence was highest in patients with CD4+ counts <200 cells/μL (52.6%) and declined progressively with higher CD4+ counts ( p = 0.04 for trend). Patients on ART had a higher prevalence of thyroid dysfunction (32.3%) compared to ART-naive patients (8.3%; p = 0.05, representing a trend toward significance rather than a definitive association). Multivariate analysis identified longer duration of HIV infection (OR: 1.38, 95% confidence intervals CI: 1.12–1.69), lower CD4+ count <350 cells/μL (Odds ratio (OR): 1.52, 95% CI: 1.18–1.96), and ART use (OR: 5.27, 95% CI: 1.14–24.36) as independently associated factors; however, the finding for ART use (OR: 5.27, 95% CI: 1.14–24.36) should be interpreted cautiously due to the small ART-naive subgroup, wide confidence intervals, and potential residual confounding.
Conclusion:
Thyroid dysfunction is prevalent among PLHIV and is associated with immunological status, highlighting the need for routine screening in clinical practice. Lower CD4+ counts and longer duration of HIV infection were independently associated with thyroid dysfunction. These findings have direct clinical implications: undetected thyroid dysfunction may worsen fatigue, metabolic disturbances, immune function, and quality of life in PLHIV. Regular screening for thyroid abnormalities is recommended, particularly in patients with low CD4+ counts and those on long-term ART.