Correlation between increased cortisol:DHEA ratio and malnutrition in HIV-positive men

Malnutrition in HIV-infected patients is characterized by a loss of both fat-free mass (FFM) and fat mass (FM). Glucocorticoids and androgens change during the course of the infection and may play a key role in the protein balance. The serum concentrations of cortisol, adrenal (DHEA and DHEA sulfate) and gonadal androgens (androstenedione, testosterone, and dihydrotestosterone) of HIV-positive men were measured and compared with several parameters of body composition as a function of body weight loss (BWL). The patients were assigned to one of five groups according to their BWL: group I (controls, n = 10) < 5%, group II (n = 7) 5-10%, group III (n = 8) 10.1-16%, group IV (n = 9) 16.1-24%, and group V (n = 4) > 24.1%. Correlation analysis showed significant positive or negative relationships between several markers of malnutrition and adrenal androgens and the cortisol:DHEA ratio, but not with cortisol. BWL was negatively correlated with DHEA (r = -0.69, P < 0.0001), DHEA sulfate (r = -0.58, P < 0.0001) and testosterone (r = -0.34, P < 0.03), but positively with the cortisol:DHEA ratio (r = 0.61, P < 0.0001). In contrast, BCM was positively correlated with DHEA (r = 0.34, P < 0.04) and DHEA sulfate (r = 0.36, P < 0.03) and negatively with the cortisol:DHEA ratio (r = -0.58, P < 0.0001). The cortisol:DHEA ratio was also negatively correlated with BMI (body mass index) (r = -0.56, P < 0.01), fat-free mass (r = -0.48, P < 0.004), fat mass (r = -0.39, P < 0.02), and BCM:weight ratio (r = -0.47, P < 0.005) and positively with the extracellular:intracellular water ratio (r = 0.54, P < 0.001). These data indicate that the steroid hormone environment of patients, particularly their cortisol:DHEA ratio, is linked to the malnutrition associated with HIV infection. The decreased DHEA and increased cortisol in patients with the advanced stages of disease could be associated with increased protein catabolism.