An HIV-positive Patient Who Developed Graves' Disease under HAART

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Objective: We encountered an HIV-positive patient who developed Graves' disease 31 months after starting HAART. Case: HIV infection was diagnosed in a 32-year-old man in July, 1999. The CD4+ count at the time was 2/μ1, and the HIV-RNA load was 2.4×105 copies/ml. He had been prescribed d4T+3TC+EFV since August, 1999. CMV-like pneumonia and CMV-like esophagitis developed immediately after starting HAART, but the lesions disappeared after administration of GCV. In addition, swollen abdominal lymph nodes resembling tuberculous lymphadenitis appeared, and he was prescribed CAM+EB+RFB+INH+PZA. His symptoms continued prolonged, but the lesions disappeared on Ga scintigraphy in August, 2001.During that period, the CD4+ count ranged from 50/μ1 to 100/μ1. The CD4+ count suddenly increased in January, 2002 and thyroid gland swelling, palpitations, and general malaise appeared in March, 2002. Graves' disease was diagnosed on the basis of thyroid function tests. Thiamazole relieved his symptoms. Comment: After starting HAART, careful follow-up to detect the onset of autoimmune disease, as well as opportunistic infection and opportunistic tumor, is necessary.
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