ABSTRACT Thyroid abnormalities have been reported in persons with HIV infection, although data have been inconsistent with respect to its frequency and association with specific medications. The purpose of this study was to explore thyroid system response to thyroid releasing hormone stimulation in persons with and without HIV infection and determine the extent to which their response was associated with depression. As part of a larger study of neuroendocrine response persons with HIV-1 infection, control and HIV-1 infected individuals were evaluated. Participants' response to TRH stimulation was evaluated via TSH, total T3, and T4 levels at baseline and 15, 30, 45, and 60 minutes after TRH stimulation. Participants with HIV infection had a more robust response to TRH stimulation as measured by higher levels of TSH, lower levels of T4 and modestly higher levels of T3. Depressed persons had a reduced TSH response to stimulation and lower levels of both T4 and T3, although the effect of depression on T4 was not statistically significant. These results suggest that TSH response to TRH-stimulation may be exaggerated in individuals with HIV infection but reduced in those with depression. They also suggest that the effects of depression and HIV infection may interact, and may provide a partial explanation for observed thyroid abnormalities in HIV-infected individuals. Results thus provide a partial explanation for findings on thyroid and depression in those affected by HIV infection.
Cite this paper
R. L. Ownby, D. Waldrop-Valverde, A. Kumar and M. Kumar, "Thyroid Function and Depression in HIV-1 Infection," World Journal of AIDS, Vol. 2 No. 4, 2012, pp. 279-285. doi: 10.4236/wja.2012.24037.
 A. Antinori, G. Arendt, J. T. Becker, et al., “Updated Research Nosology for HIV-Associated Neurocognitive Disorders,” Neurology, Vol. 69, No. 18, 2007, pp. 1789-1799. doi:10.1212/01.WNL.0000287431.88658.8b
 I. Grant, “Neurocognitive Disturbances in HIV,” International Review of Psychiatry, Vol. 20, No. 1, 2008, pp. 33-47. doi:10.1080/09540260701877894
 M. Reger, R. Welsh, J. Razani, et al., “A Meta-Analysis of the Neuropsychological Sequelae of HIV Infection,” Journal of the International Neuropsychological Society, Vol. 8, No. 3, 2002, pp. 410-424.
 J. A. Aberg, “Cardiovascular Risk Among HIV-Positive Patients on Antiretroviral Therapy,” Journal of International Association of Physicians in AIDS Care (Chic Ill), Vol. 2, Suppl. 2, 2003, pp. S24-S39.
 G. Barbaro and G. Barbarini, “Highly Active Antiretroviral Therapy-Associated Metabolic Syndrome and Cardiovascular Risk,” Chemotherapy, Vol. 52, No. 4, 2006, pp. 161-165. doi:10.1159/000093034
 F. Chen, S. L. Day, R. A. Metcalfe, et al., “Characteristics of Autoimmune Thyroid Disease Occurring as a Late Complication of Immune Reconstitution in Patients With Advanced Human Immunodeficiency Virus (HIV) Disease,” Medicine (Baltimore), Vol. 84, No. 2, 2005, pp. 98-106. doi:10.1097/01.md.0000159082.45703.90
 V. Jubault, A. Penfornis, F. Schillo, et al., “Sequential Occurrence of Thyroid Autoantibodies and Graves’ Disease after Immune Restoration in Severely Immuno-compromised Human Immunodeficiency Virus-1-Infected Patients,” Journal of Clinical Endocrinology & Metabolism, Vol. 85, No. 11, 2000, pp. 4254-4257.
 A. Antonelli, C. Ferri, P. Fallahi, et al., “Thyroid Disorders in Chronic Hepatitis C Virus Infection,” Thyroid, Vol. 16, No. 6, 2006, pp. 563-572.
 C. J. Hoffmann and T. T. Brown, “Thyroid Function Abnormalities in HIV-Infected Patients,” Clinical Infectious Diseases, Vol. 45, No. 4, 2007, pp. 488-494.
 T. Quirino, M. Bongiovanni, E. Ricci, et al., “Hypothyroidism in HIV-Infected Patients Who Have or Have Not Received HAART,” Clinical Infectious Diseases, Vol. 38, No. 4, 2004, pp. 596-597. doi:10.1086/381442
 W. W. Tang and E. M. Kaptein, “Thyroid Hormone Levels in the Acquired Immunodeficiency Syndrome (AIDS) or AIDS-Related Complex,” West Journal of Medicine, Vol. 151, No. 6, 1989, pp. 627-631.
 S. Beltran, F. X. Lescure, R. Desailloud, et al., “Increased Prevalence of Hypothyroidism among Human Immunodeficiency Virus-Infected Patients: A Need for Screening,” Clinical Infectious Diseases, Vol. 37, No. 4, 2003, pp. 579-583. doi:10.1086/376626
 M. Wiener, Y. Lo and R. S. Klein, “Abnormal Thyroid Function in Older Men with or at Risk for HIV Infection,” HIV Medicine, Vol. 9, No. 7, 2008, pp. 544-549. doi:10.1111/j.1468-1293.2008.00601.x
 L. Calza, R. Manfredi and F. Chiodo, “Subclinical Hypothyroidism in HIV-Infected Patients Receiving Highly Active Antiretroviral Therapy,” Journal of Acquired Immune Deficiency Syndromes, Vol. 31, No. 3, 2002, pp. 361-363. doi:10.1097/00126334-200211010-00014
 J. Barroso, “A Review of Fatigue in People with HIV Infection,” Journal of the Association of Nurses in AIDS Care, Vol. 10, No. 5, 1999, pp. 42-49.
 J. Barroso, J. R. Carlson and J. Meynell, “Physiological and Psychological Markers Associated with HIV-Related Fatigue,” Clinical Nursing Research, Vol. 12, No. 1, 2003, pp. 49-68. doi:10.1177/1054773803238740
 S. Beltran, F. Lescure, I. El Esper, et al., “Subclinical Hypothyroidism in HIV-Infected Patients Is Not an Autoimmune Disease,” Hormone Research, Vol. 66, No. 1, 2006, pp. 21-26. doi:10.1159/000093228
 S. Afhami, V. Haghpanah, R. Heshmat, et al., “Assessment of the Factors Involving in the Development of Hypothyroidism in HIV-Infected Patients: A Case-Control Study,” Infection, Vol. 35, No. 5, 2007, pp. 334-338. doi:10.1007/s15010-007-6163-3
 M. Nelson, T. Powles, A. Zeitlin, et al., “Thyroid Dysfunction and Relationship to Antiretroviral Therapy in HIV-Positive Individuals in the HAART Era,” Journal of Acquired Immune Deficiency Syndromes, Vol. 50, No. 1, 2009, pp. 113-114.
 G. Madeddu, A. Spanu, F. Chessa, et al., “Thyroid Function in Human Immunodeficiency Virus Patients Treated with Highly Active Antiretroviral Therapy (HAART): A Longitudinal Study,” Clinical Endocrinology (Oxf), Vol. 64, No. 4, 2006, pp. 375-383.
 M. Grappin, L. Piroth, B. Verges, et al., “Increased Prevalence of Subclinical Hypothyroidism in HIV Patients Treated with Highly Active Antiretroviral Therapy,” AIDS, Vol. 14, No. 8, 2000, pp. 1070-1072.
 S. Madge, C. J. Smith, F. C. Lampe, et al., “No Association between HIV Disease and Its Treatment and Thyroid Function,” HIV Medicine, Vol. 8, No. 1, 2007, pp. 22-27. doi:10.1111/j.1468-1293.2007.00422.x
 J. Collazos, S. Ibarra, and J. Mayo, “Thyroid Hormones in HIV-Infected Patients in the Highly Active Anti-retroviral Therapy Era: Evidence of an Interrelation between the Thyroid Axis and the Immune System,” AIDS, Vol. 17, No. 5, 2003, pp. 763-765.
 G. Jain, G. Devpura and B. S. Gupta, “Abnormalities in the Thyroid Function Tests as Surrogate Marker of Advancing HIV Infection in Infected Adults,” Journal of the Association of Physicians of India, Vol. 57, 2009, pp. 508-510.
 M. Bongiovanni, F. Adorni, M. Casana, et al., “Subclinical Hypothyroidism in HIV-Infected Subjects,” Journal of Antimicrobial Chemotherapy, Vol. 58, No. 5, 2006, pp. 1086-1089. doi:10.1093/jac/dkl360
 J. Barroso, B. W. Pence, N. Salahuddin, et al., “Physiological Correlates of HIV-Related Fatigue,” Clinical Nursing Research, Vol. 17, No. 1, 2008, pp. 5-19.
 N. H. Brockmeyer, A. Kreuter, A. Bader, et al., “Prevalence of Endocrine Dysfunction in HIV-Infected Men,” Hormone Research, Vol. 54, No. 5-6, 2000, pp. 294-295.
 I. M. Jackson, “The Thyroid Axis and Depression,” Thyroid, Vol. 8, No. 10, 1998, pp. 951-956.
 C. Kirkegaard and J. Faber, “The Role of Thyroid Hormones in Depression,” European Journal of Endocrinology, Vol. 138, No. 1, 1998, pp. 1-9.
 R. Cooper-Kazaz, J. T. Apter, R. Cohen, et al., “Combined Treatment With Sertraline and Liothyronine in Major Depression: A Randomized, Double-Blind, Placebo-Controlled Trial,” Archives of General Psychiatry, Vol. 64, No. 6, 2007, pp. 679-688.
 T. Kelly and D. Z. Lieberman, “The Use of Triiodo-thyronine as an Augmentation Agent in Treatment-Resistant Bipolar II and Bipolar Disorder NOS,” Journal of Affective Disorders, Vol. 116, No. 3, 2009, pp. 222-226. doi:10.1016/j.jad.2008.12.010
 T. F. Kelly and D. Z. Lieberman, “Long Term Augmentation with T3 in Refractory Major Depression,” Journal of Affective Disorders, Vol. 115, No. 1-2, 2009, pp. 230-233. doi:10.1016/j.jad.2008.09.022
 R. L. Ownby, R. J. Jacobs, D. Waldrop-Valverde, et al., “Depression Care and Prevalence in HIV-Positive Individuals,” Journal of Neurobehavioral HIV Medicine, Vol. 2, 2010, pp. 73-83. doi:10.2147/NBHIV.S7296
 J. A. Ciesla and J. E. Roberts, “Meta-Analysis of the Relationship between HIV Infection and Risk for Depressive Disorders,” American Journal of Psychiatry, Vol. 158, No. 5, 2001, pp. 725-730.
 E. G. Bing, M. A. Burnam, D. Longshore, et al., “Psychiatric Disorders and Drug Use among Human Immunodeficiency Virus-Infected Adults in the United States,” Archives of General Psychiatry, Vol. 58, No. 8, 2001, pp. 721-728. doi:10.1001/archpsyc.58.8.721
 A. T. Beck, C. H. Ward , M. Mendelson, et al., “An Inventory for Measuring Depression,” Archives of General Psychiatry, Vol. 4, No. 6, 1961, pp. 561-571.
 T. Forkmann, T. Vehren, M. Boecker, et al., “Sensitivity and Specificity of the Beck Depression Inventory in Cardiologic Inpatients: How Useful Is the Conventional Cut-Off Score?” Journal of Psychosomatic Research, Vol. 67, No. 4, 2009, pp. 347-352.
 P. J. Lustman, R. E. Clouse, L. S. Griffith, et al., “Screening for Depression in Diabetes Using the Beck Depression Inventory,” Psychosomatic Medicine, Vol. 59, No. 1, 1997, pp. 24-31.
 K. N. Fountoulakis, A. Iacovides, P. Grammaticos, et al., “Thyroid Function in Clinical Subtypes of Major Depression: An Exploratory Study,” BMC Psychiatry, Vol. 4, 2004, p. 6. doi:10.1186/1471-244X-4-6
 M. P. Hage and S. T. Azar, “The Link between Thyroid Function and Depression,” Journal of Thyroid Research, Vol. 2012, 2012, Article ID: 590648.
 C. B. Nemeroff, J. S. Simon, J. J. Haggerty Jr., et al., “Antithyroid Antibodies in Depressed Patients,” American Journal of Psychiatry, Vol. 142, No. 7, 1985, pp. 840-843.
 G. Zandman-Goddard and Y. Shoenfeld, “HIV and Autoimmunity,” Autoimmunity Reviews, Vol. 1, No. 6, 2002, pp. 329-337. doi:10.1016/S1568-9972(02)00086-1