Differences in Endocrine Manifestations in HIV-Infected Subjects on Anti-Retroviral Therapy (ART) Versus not on ART

Few studies have examined endocrine dysfunction associated with anti-retroviral therapy (ART) for human immunodeficiency virus (HIV) infection. The aim is to assess various endocrine changes, including vitamin D metabolism and glycaemic status, of subjects on ART versus not on ART (non-ART) and to assess the relationship with CD4 + T helper cell count.

Ninety-three HIV-positive subjects were selected and underwent thyroid function tests (thyroid stimulating hormone and free thyroxine). Fasting plasma glucose, glycated haemoglobin, Cortisol, ACTH, total testosterone (male), follicle stimulating hormone, luteinising hormone, Prolactin, 25(OH) D, intact parathyroid hormone, calcium, phosphorus, albumin and magnesium levels, and CD4+ T-helper cell counts were performed in all subjects.

There was a positive correlation between vitamin D and CD4 count (r = 0.33, P = 0.043) and severe vitamin D deficiency (30% in ART vs. 6.00% in non-ART; P = 0.035). 37.50% of the ART group had secondary hyperparathyroidism, compared to 12.10% of the non-ART cohort (P = 0.014). The most common adrenal dysfunction was found to be primary adrenal insufficiency, followed by adrenal excess and secondary adrenal insufficiency (17.50%, 10.00% and 2.50% in ART vs. 15.00%, 12.00% and 6.00% in the non-ART group); male hypogonadism was seen in 22.70% of patients in the ART group versus 14% in the non-ART group (P = 0.064). The most common thyroid dysfunctions found in the ART cohort were secondary hypothyroidism (30%), subclinical hypothyroidism (10%), and primary hypothyroidism (2.50%).

Our study showed endocrine dysfunction more common in patients who received ART than in those who did not. Severe vitamin D deficiency was also common in the ART group. Serum vitamin D levels were positively correlated with CD4+ T cell counts.