Effects Of Highly Active Antiretroviral Therapy (HAART) On Thyroid Function In AIDS Patients

ObjectiveTo discuss the Effects of highly active antiretroviral therapy（HAART）and HAART regimens on thyroid function in patients with AIDS.In order to guide clinicians in the assessment,diagnosis and treatment of thyroid function in AIDS patients.MethodsThe clinical data of 1276 AIDS patients hospitalized in Guangzhou Eighth People’s Hospital Affiliated to Guangzhou Medical University from June 2017 to May 2020 were retrospectively collected for this cross-sectional study.All patients were screened by ELISA and confirmed as HIV antibody positive by WB.This research was divided into two parts:the effect of HAART on thyroid function and the effect of HAART regimen on thyroid function.In part 1,a total of 176 patients were enrolled,including 135 males and 41 females.A total of 83 patients were enrolled in the second part,including 60 male patients and 23 female patients.The patient’s gender,age,HIV duration,HAART/HAART duration,HAART regimen,CD4⁺T lymphocyte count,free triiodothyronine（FT₃）,free thyroxine（FT₄）,thyroid stimulating hormone（TSH）,thyroid peroxidase antibody（TPOAb）,thyroglobulin antibody（TGAb）,thyroid stimulating receptor antibody（TRAb）,alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,serum creatinine（Cr）,etc at admission were collected.Independent sample T test,non-parametric test and chi-square test were used for comparison between groups,and Logistic regression analysis was used for univariate/multivariate analysis to evaluate the differences in the prevalence of thyroid dysfunction,the differences in the types of thyroid dysfunction,and the correlation between HAART and thyroid dysfunction in HIV patients.Results（1）Patients were divided into HAART group and no-HAART group according to whether receiving HAART or not.In HAART group,the median duration of disease was 5.00（2.00-10.00）years,the average BMI was 22.22±3.29kg/m²,the median CD4+count was 283.00（86.00-438.00）cells/μl,and the average FT₃4.23±1.38pmol/L,the median Cr 72.40（60.55-90.15）umol/L were significantly higher than those of no-HAART group（P<0.05）.While the median AST was 23.30（17.00-39.60）U/L,significantly lower than those of no-HAART group（P<0.05）.（2）According to whether the thyroid function was abnormal at admission,the patients were divided into abnormal thyroid function group and normal thyroid function group.The median duration of HAART（2.00（0.00-5.00））,CD4⁺T lymphocyte count（217.50（71.0-373.25））,mean FT₃（4.33±0.79）and mean FT₄（15.41±2.13）were significantly higher in normal thyroid function group than those in abnormal thyroid function group.（3）The prevalence of thyroid dysfunction in HAART group was significantly lower than that in no-HAART group（40.96%vs.65.59%,P<0.05）.Low T₃ syndrome had the highest prevalence（27.84%）.The prevalence of low T₃ syndrome in HAART group patients with thyroid dysfunction was significantly lower than that in no-HAART group（14.46%vs.39.78%）.（4）Univariate/multivariate Logistic regression analysis showed that HAART and CD4⁺T cell count were independent protective factors for thyroid dysfunction in AIDS patients.Univariate/multivariate Logistic regression analysis showed that HAART was an independent protective factor for isolated low T₄ in AIDS patients.（5）There was no significant difference in the prevalence of thyroid dysfunction and the proportion of thyroid dysfunction among the different treatment groups.There was no significant difference in thyroid function indexes between the treatment groups with different HAART duration and CD4⁺T lymphocyte levels.Conclusions（1）AIDS patients have a higher prevalence of thyroid dysfunction.The prevalence of thyroid dysfunction in the no-HAART group was significantly higher than that in the HAART group.（2）The most common thyroid dysfunction in AIDS patients is low T₃ syndrome.（3）HAART and CD4⁺T lymphocyte count are independent protective factors for thyroid dysfunction in AIDS patients.（4）Different HAART regimens and treatment duration have no significant effect on thyroid function in AIDS patients.CD4⁺T cell count has no significant correlation with TSH,FT₄,FT₃.