{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:14:35Z","timestamp":1787238875533,"version":"build-2736575974"},"reference-count":0,"publisher":"Bioscientifica","license":[{"start":{"date-parts":[[2021,10,1]],"date-time":"2021-10-01T00:00:00Z","timestamp":1633046400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,10,1]]},"abstract":"\n Summary<\/jats:title>\n Both human immunodeficiency virus (HIV) and antiretroviral therapy (ART) are associated with endocrine dysfunction (1). The term 'immune reconstitution inflammatory syndrome' (IRIS) describes an array of inflammatory conditions that occur during the return of cell-mediated immunity following ART. Graves\u2019 disease (GD) occurs rarely as an IRIS following ART. In this study, we describe the case of a 40-year-old Brazilian female who was diagnosed with HIV following admission with cryptococcal meningitis and salmonellosis. At this time, she was also diagnosed with adrenal insufficiency. Her CD4 count at diagnosis was 17 cells\/\u00b5L which rose to 256 cells\/\u00b5L over the first 3 months of ART. Her HIV viral load, however, consistently remained detectable. When viral suppression was finally achieved 21 months post diagnosis, an incremental CD4 count of 407 cells\/\u00b5L over the following 6 months ensued. Subsequently, she was diagnosed with a late IRIS to cryptococcus 32 months following initial ART treatment, which manifested as non-resolving lymphadenitis and resolved with high-dose steroids. Following the initiation of ART for 45 months, she developed symptomatic Graves\u2019 hyperthyroidism. At this time, her CD4 count had risen to 941 cells\/\u00b5L. She has been rendered euthyroid on carbimazole. This case serves to remind us that GD can occur as an IRIS post ART and typically has a delayed presentation.<\/jats:p>\n <\/jats:sec>\n \n Learning points<\/jats:title>\n \n \n Endocrinologists should be aware of the endocrine manifestations of HIV disease, in particular, thyroid pathology.<\/jats:p>\n <\/jats:list-item>\n \n Endocrinologists should be aware that IRIS can occur following the initiation of ART.<\/jats:p>\n <\/jats:list-item>\n \n Thyroid dysfunction can occur post ART of which Graves' disease (GD) is the most common thyroid manifestation.<\/jats:p>\n <\/jats:list-item>\n \n GD as a manifestation of ART-induced IRIS can have a delayed presentation.<\/jats:p>\n <\/jats:list-item>\n \n Infectious disease physicians should be aware of endocrine manifestations associated with HIV and ART.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>","DOI":"10.1530\/edm-21-0094","type":"journal-article","created":{"date-parts":[[2021,10,6]],"date-time":"2021-10-06T06:25:40Z","timestamp":1633501540000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":7,"title":["Graves\u2019 disease associated with HIV disease and late immune reconstitution inflammatory syndrome following the initiation of antiretroviral therapy"],"prefix":"10.1530","volume":"2021","author":[{"given":"S","family":"Ludgate","sequence":"first","affiliation":[{"name":"1Department of Diabetes and Endocrinology, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S P","family":"Connolly","sequence":"additional","affiliation":[{"name":"2Department of Infectious Diseases, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Fennell","sequence":"additional","affiliation":[{"name":"1Department of Diabetes and Endocrinology, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M F","family":"Muhamad","sequence":"additional","affiliation":[{"name":"1Department of Diabetes and Endocrinology, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I","family":"Welaratne","sequence":"additional","affiliation":[{"name":"3Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Cotter","sequence":"additional","affiliation":[{"name":"2Department of Infectious Diseases, Dublin, Ireland"},{"name":"4School of Medicine, University College Dublin, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S E","family":"McQuaid","sequence":"additional","affiliation":[{"name":"1Department of Diabetes and Endocrinology, Dublin, Ireland"},{"name":"4School of Medicine, University College Dublin, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","container-title":["Endocrinology, Diabetes & Metabolism Case Reports"],"original-title":[],"link":[{"URL":"https:\/\/edm.bioscientifica.com\/view\/journals\/edm\/2021\/1\/EDM21-0094.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2021\/1\/EDM21-0094.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:47:43Z","timestamp":1784555263000},"score":1,"resource":{"primary":{"URL":"http:\/\/journals.bioscientifica.com\/edm\/article\/3674"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,1]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1530\/edm-21-0094","relation":{},"ISSN":["2052-0573"],"issn-type":[{"value":"2052-0573","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,1]]}}}