Thyroid Abnormalities Possible in Patients Living With HIV

Patients living with HIV have a risk of developing thyroid abnormalities, according to a review published in AIDS Research and Therapy.¹ Monitoring thyroid dysfunction is therefore imperative for catching potential hypothyroidism and its associated health outcomes in the vulnerable population.

Although people living with HIV can live longer now due to highly active antiretroviral therapy (HAART), the prolonged life expectancy also can introduce challenges related to immunodeficiency, with studies finding that patients with HIV can live up to 16.3 fewer healthy years compared with adults who do not have HIV.² The prevalence of thyroid diseases in people with HIV and disparities in data that may exist remain unknown, which can leave patients vulnerable if they are not prepared properly. This review aimed to summarize current evidence of the link between thyroid dysfunction and HIV.

Monitoring the thyroid in patients with HIV can help prevent an escalation of adverse events | Image credit: © Peakstock - stock.adobe.com

Researchers used PubMed, Web of Science, ScienceDirect, and the World Health Organization Virtual Health Library Regional Portal to collect literature for this review, investigating literature published from the inception of the databases through July 2024. Cross-sectional, case-control, and cohort studies were eligible for inclusion in this review whereas case reports, editorials, reviews, abstracts, and studies without enough data were excluded.

There were 30 studies included in the review after extensive search. Overt hypothyroidism, isolated low FT4, subclinical hypothyroidism, sick euthyroid syndrome, and overt hyperthyroidism were the most common types of thyroid dysfunction in people living with HIV; thyroid cancers and subclinical hyperthyroidism were also reported in the studies included.

The prevalence of thyroid dysfunction was 7.7% (95% CI, 5.0%-11.7%) overall. Hypothyroidism had a prevalence of 2.7% (95% CI, 1.7%-4.4%), which was the highest of the different thyroid dysfunctions. This was followed by a 2.47% (95% CI, 1.2%-4.6%) prevalence of euthyroid syndrome, a 1.80% (95% CI, 0.90%-3.30%) prevalence of isolated hypothyroxinemia, and a 0.7% (95% CI, 0.4%-1.10%) prevalence of overt hyperthyroidism. A pooled effect size analysis found that patients with HIV and hypothyroidism had a lower CD4 count compared with patients with HIV and without a thyroid dysfunction (standard mean difference, –0.604; 95% CI, –0.947 to –0.257).

There were some limitations to this study. The included studies had similar methods of measuring and describing the data, which were limited, and bias was potentially introduced through the variations in the study designs of the included studies. Patients with coinfections, such as those with both HIV and human papillomavirus, were excluded from the review. This review also only included studies that were published in the English language.

The researchers concluded that the occurrence of clinical thyroid diseases is uncommon in patients living with HIV. However, they believed that “thyroid functions in HIV patients or those with advanced disease or immunosuppression should be monitored due to the potential for progression to overt hypothyroidism and associated adverse health outcomes.” Understanding thyroid dysfunction can help those living with HIV who have severe immune suppression.

References

1. Mohamed SOO, Mohamed KO, Mohamed AAB, et al. Thyroid disorders in patients with human immunodeficiency virus infection: a meta-analysis. AIDS Res Ther. 2025;22(1):2. doi:10.1186/s12981-024-00697-2

2. Marcus JL, Leyden WA, Alexeeff SE, et al. Comparison of overall and comorbidity-free life expectancy between insured adults with and without HIV infection, 2000-2016. JAMA Netw Open. 2020;3(6):e207954. doi:10.1001/jamanetworkopen.2020.7954