Prevalence and Clinical Associations of Adrenal Dysfunction in People Living with Human Immunodeficiency Virus: A...

Adrenal insufficiency (AI) is more prevalent in people living with human immunodeficiency virus (HIV) (PLHIV) than in the general population, yet screening is infrequent. Untreated disease may have grave consequences, including death. This study assessed AI's prevalence and predictive factors in both stable and advanced PLHIV Indian populations and their short-term outcomes.

Participants were classified based on World Health Organization (WHO) clinical stage and cluster of differentiation (CD) 4 count. Group 1 included those with advanced disease (CD4 < 200 or stage 3/4), while Group 2 had stable disease (CD4 > 200, stage 1/2). An Acton Prolongatum^® (Ferring Pharmaceuticals, India) stimulation test measured cortisol at 0, 60 and 120 min. Baseline characteristics and risk factors were compared between AI and non-AI patients, with follow-up for clinical outcomes.

In Group 1, AI was observed in 30.56% and 19.44% of participants at stimulated 120-min cortisol levels below 19.5 μg/dL and 18 μg/dL, respectively, while in Group 2, it was seen in 71.43% and 48.57%, respectively. In univariate analysis for predicting AI, hyponatraemia emerged as a significant variable (odds ratio (OR): 10.8, 95% confidence interval (CI): 1.2-97.7, P = 0.009), especially in advanced HIV (Group 1) (91% vs. 48%, P = 0.01). Group 1 exhibited significantly higher basal cortisol levels (median 14.3 vs. 10.3, P < 0.001), lower dehydroepiandrosterone sulphate (DHEA-S) (75% vs. 40%, P = 0.003), and a higher cortisol/DHEA-S ratio (63.9% vs. 5.7%, P < 0.001) compared to Group 2.

AI is prevalent in PLHIV, emphasizing the need for screening. Hyponatraemia may aid targeted screening. Low DHEA-S, elevated basal cortisol and high cortisol/DHEA-S ratios are markers of advanced HIV and increased mortality.