HAART. Graves HIV +/2. Highly active antiretroviral therapy : HAART human immunodeficiency virus : HIV-RNA acquired immunodeficiency syndrome : AIDS

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1 ,**- The Japanese Society for AIDS Research The Journal of AIDS Research HAART Graves HIV : HAART -+ CD. Graves HIV + : -, CD.,/ml, HIV-RNA,..+* / copiesml HIV 2 EFV HAART CMV CMV GCV CAMEBRFBINHPZA,**+ 2 Ga CD. /*+**ml,**, + CD. - Graves : HAART : Graves HIV HAART / : +/2+0,,**- Highly active antiretroviral therapy : HAART human immunodeficiency virus : HIV CD. T CD. HIV-RNA acquired immunodeficiency syndrome : AIDS HIV HAART HAART -+ CD. Graves + : +0***,- 01+ Fax : *---.*/..2 moriken@tokyo-med.ac.jp,**- -,/ ;,** , HIV CD.,/ml, HIV-RNA,..+* / copiesml +.** mg 2* mg ST + CAM 2** mg 2 0* mg -** mg EFV 0** mg HAART 3 GCV 0** mg HAART,*** - EB 1/* mg RFB -** mg INH -** mg PZA +,/** mg,*** +, +/2 +,

2 The Journal of AIDS Research Vol. / No. -,**- +,**+ 2 HAART,3,**, + /*ml +**ml CD. - FT. FT- TSH TSH Graves + HAART MMI -* mg MMI, 2 CMV +. HAART CMV CMV HAART CD. CD. CD. / CD. Graves TSH TSH * : +* Merseburg - IgG T 0 HAART Graves 3, 13 HAART Graves Graves Graves C HIV HAART +* HAART Graves 13 +/3 +-

3 K Moriya et al. : An HIV-positive Patient Who Developed Graves Disease under HAART + Graves WBC,,1**2,2**ml RBC -.1/..+* 0 ml Hb ++.*+1.* gdl PLT +.*.*-.*.*+* - ml Neu.,.*1..* Eo *.*0.* Ba *.*,.* Lym +3.*.1.* Mo,.*2.* CRP *.- mgdl CD. CD.,//0 CD2 CD HIV-RNA HBsAg HCVAb RPR TPHA FT-, ngdl FT. *.3/+.2 ngdl TSH *.,/ muml TSH /,0**ml...1+* 0 ml +,.+ gdl,,*+* - ml -1.3 *.1 *., +, mgdl, ml *.-,..+* / copiesml Graves 1,0**ml../3+* 0 ml +..3 gdl -.++* - ml 00.* *.2 *.+,/./ 1.0 *.- mgdl,0-ml ,***ml /+.0 /.*+* + copiesml,/ ngdl 0.2 ngdl *., muml 3+.,, +0* +.

4 The Journal of AIDS Research Vol. / No. -,**-, Gilquin 1 Sereti 2 Jubault 3.+., -0 -* -0.+.,,.., -, HAART RTV NFV RTV EFV HAART Graves +3 +0,, +1,,,,,* +. +/ -+ HAART CD. +.*ml 0,ml *ml 0.ml *ml +.ml 0,ml +0ml *ml,ml Graves CD. -0*ml -.*ml +0-ml 031ml +0-ml -0*ml -.*ml.0*ml +00ml,0-ml ; Indinavir, RTV ; Ritonavir, NFV ; Nelfinavir HIV Graves ++, +, CD. CD. +- Zandman-Goddard ++ HIV AIDS HAART CD. CD2 CD2 HAART -+ Graves + HIV + Lederman MM, Valdez H : Immune restoration with antiretroviral therapies. JAMA,2. :,,-,,2,,***., DeSimone JA, Pomerantz RJ, Babinchak TJ : Inflammatory reactions in HIV-+ infected persons after initiation of highly active antiretroviral therapy. Ann Intern Med +-- :..1./.,,***. - Ledergerber B, Egger M, Erard V, Weber R, Hirschel B, Furrer H, Battegay M, Vernazza P, Bernasconi E, Opravil M, Kaufmann D, Sudre P, Francioli P, Telenti A : AIDS-related opportunistic illnesses occurring after initiation of potent antiretroviral therapy. The Swiss HIV cohort study. JAMA,2, :,,,*,,,0, Collazos J, Ojanguren J, Mayo J, Martinez E, Ibarra S : Lymphoma developing shortly after the onset of highly active antiretroviral therapy in HIV-infected patients. AIDS +0 : +-*.+-*0,,**,. / Autran B, Carcelain G, Li TS, Blanc C, Mathez D, Tubiana R, Katlama C, Debre P, LeibowitchJ : Positive e#ects of combined antiretroviral therapy on CD. T cell homeostasis and function in advanced HIV disease. Science,11 : ++,++0, Weetman AP : Graves disease. N Engl J Med -.- : +,-0+,.2,,***. 1 Gilquin J, Viard JP, Jubault V, Sert C, Kazatchkine MD : Delayed occurrence of Graves disease after immune restoration withhaart. Lancet -/, : +3*1 +3*2, Sereti I, Sarlis NJ, Arioglu E, Turner ML, Mican JM : Alopecia universalis and Graves disease in the setting of immune restoration after highly active antiretroviral therapy. AIDS +/ : +-2+.*,,** /

5 K Moriya et al. : An HIV-positive Patient Who Developed Graves Disease under HAART 3 Jubault V, Penfornis A, Schillo F, Hoen B, Izembart M, Timsit J, Kazatchkine MD, Gilquin J, Viard JP : Sequential occurrence of thyroid autoantibodies and Graves disease after immune restoration in severely immunocompromised human immunodeficiency virus-+infected patients. J Clin Endocrinol Metab 2/ :.,/..,/1,,***. +* Martin-Carbonero L, Nunez M, Rios P, Perez-Olmeda M, Gonzalez-Lahoz J, Soria V : Liver injury after beginning antiretroviral therapy in HIV/hepatitis C virus coinfected patients is not related to immune reconstitution. AIDS +0 : +.,-+.,/,,**,. ++ Zandman-Goddard G, Shoenfeld Y : HIV and autoimmunity. Autoimmunity Rev + : -,3--1,,**,. +, : HIV. : +*2++/,**,. +- Coutinho A, Hori S, Carvalho T, Caramalho I, Demengeot J : Regulatory T cells : the physiology of autoreactivity in dominant tolerance and quality control of immune responses. Immunol Rev +2, : 2332,,**+. An HIV-positive Patient Who Developed Graves Disease under HAART Kenji MORIYA, Kagehiro AMANO, Akihito SASAKI, Koh YAMANAKA, Susumu FUJITA, Taito UCHIDA and Katsuyuki FUKUTAKE Department of Laboratory Medicine, Tokyo Medical University Objective : We encountered an HIV-positive patient who developed Graves disease -+ months after starting HAART. Case : HIV infection was diagnosed in a -,-year-old man in July, The CD. count at the time was,/ml, and the HIV-RNA load was,..+* / copies/ml. He had been prescribed EFV since August, 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 CAMEBRFBINHPZA. His symptoms continued prolonged, but the lesions disappeared on Ga scintigraphy in August,,**+. During that period, the CD. count ranged from /*/ml to+**/ml. The CD. count suddenly increased in January,,**, and thyroid gland swelling, palpitations, and general malaise appeared in March,,**,. 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. Key words : Graves disease, Immune Reconstitution Syndrome, HIV, HAART +0, +0