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Research on the presence of thyroid abnormalities in HIV showed that patients with HIV are at risk for developing a variety of thyroid disorders.

Available data on the burden of thyroid abnormalities in patients with HIV, particularly the prevalence and interaction with HIV-related factors (eg, CD4 count), are controversial.

To address the disparity, Sagad O. O. Mohamed, MBBS, and colleagues conducted a literature review to examine the presence of thyroid function abnormalities in patients with HIV infection and its associated factors.

Thyroid Disorders in HIV

A total of 30 studies met the eligibility criteria and were included in the meta-analysis. For the analysis, they calculated the pooled prevalence and standardized mean difference (SMD) estimates.

The research, published in AIDS Research and Therapy, showed that patients with HIV can develop a variety of thyroid disorders, with subclinical hypothyroidism being the most common (7.7%; 95% CI, 5.0%-11.7%). Other common thyroid disorders were overt hypothyroidism (2.7%; 95% CI, 1.7%-4.4%), sick euthyroid syndrome (2.47%; 95% CI, 1.2%-4.6%), isolated low free thyroxine (FT₄) level (1.80%; 95% CI, 0.90%-3.30%), and overt hyperthyroidism (0.7%; 95% CI, 0.4%-1.10%).

“The disparity in the reported prevalence rates among the included studies can be attributed to various factors related to the baseline characteristics of the study populations, such as their geographic location, ethnicity, and age distribution,” the authors explained.

The pooled effect size analysis showed that patients with HIV and hypothyroidism had significantly lower CD4 counts than patients with HIV without thyroid dysfunction, with SMD of −0.604 (95% CI, −0.947 to −0.257; P<0.001). In addition, the researchers found that only FT₄ levels had significant differences between patients with HIV and healthy patients, with the pooled SMD of −2.086 (95% CI, −3.740 to −0.432; P=0.013).

From a clinical perspective, the findings from the review have practical implications, the authors noted. The low prevalence of overt thyroid dysfunction reaffirm reports that do not recommend routine thyroid dysfunction testing for all patients with HIV. They also pointed out that there is no consensus on routinely assessing thyroid function in all asymptomatic patients living with HIV.

Furthermore, the findings indicate that patients with advanced HIV could benefit from thyroid function monitoring because of the association between low CD4 count and thyroid dysfunction.

“Additional research is necessary to establish a definitive understanding of the thyroid functions abnormalities in individuals living with HIV, especially in those with severe immune suppression,” the researchers concluded.