Dysfunction of the hypothalamic-pituitary-adrenal axis in HIV infection and disease

Abnormalities of the hypothalamic-pituitary-adrenal (HPA) axis have been documented in HIV patients in the early as well as late stages of the infection and range from subtle subclinical disturbances to frank adrenal insufficiency. Potential etiologies of these disorders include opportunistic infections, neoplasms, drugs administered to treat infections, cytokine abnormalities associated with the HIV disease process and acquired alterations in tissue sensitivity to glucocorticoids. In this article, we present a concise review of HPA abnormalities in HIV infection and disease with regard to their etiology with emphasis on syndromes of hypersensitivity/resistance to glucocorticoids associated with antiviral medications and/or the HIV infection itself.