Graves' Disease During Immune Reconstitution After Highly Active Antiretroviral Therapy for HIV Infection: Evidence of Thymic Dysfunction

Martyn French, S.R. Lewin, C. Dykstra, R. Krueger, Patricia Price, Peter Leedman

    Research output: Contribution to journalReview article

    49 Citations (Scopus)

    Abstract

    A patient with HIV infection who experienced immune reconstitution after highly active antiretroviral therapy (HAART) [increase in CD4 T cell count from 600/mul] presented with severe Graves' disease 32 months after commencing HAART. A comprehensive clinical and laboratory study demonstrated pronounced regional lymphadenopathy and thymic enlargement at presentation, and that the onset of thyrotropin receptor antibody production was associated with increased production of soluble CD30 (a marker of type 2 immune responses). Blood naive CD8 T cell counts and TREC levels in both CD4 and CD8 T cells were increased at multiple time points compared with carefully selected controls. We conclude that the Graves' disease in this patient was associated with abnormally high blood counts of thymus-derived T cells, and propose that Graves' disease after HAART in this and other HIV patients may result from failure to delete autoreactive T cell clones in the regenerating thymus.
    Original languageEnglish
    Pages (from-to)157-162
    JournalAIDS Research and Human Retroviruses
    Volume20
    Issue number2
    DOIs
    Publication statusPublished - 2004

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