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Hypothalamo-pituitary-adrenal function in human immunodeficiency virus-infected men
O Lortholary1, N Christeff, P Casassus
1Service de Médecine Interne, Hôpital Avicenne, Université Paris-Nord, Bobigny, France.
The Journal of Clinical Endocrinology and Metabolism
|February 1, 1996
Summary
Human immunodeficiency virus (HIV) infection impacts adrenal function, with elevated cortisol levels correlating negatively with CD4 cell counts in advanced stages. While cosyntropin tests were normal, many patients showed abnormal responses to ovine corticotropin-releasing hormone (oCRH).
Area of Science:
- Endocrinology
- Infectious Diseases
- Immunology
Background:
- Human immunodeficiency virus (HIV) infection is known to affect various endocrine functions.
- Adrenal insufficiency can be a complication in advanced HIV disease, impacting patient health and prognosis.
Purpose of the Study:
- To investigate adrenal function in male patients with HIV infection.
- To assess basal hormone levels, circadian rhythms, and responses to stimulation tests in relation to disease stage and CD4 cell count.
Main Methods:
- Prospective study of 51 HIV-positive male patients (stages II/III and IVC).
- Measured basal serum cortisol (F), progesterone (P4), and 17 alpha-hydroxyprogesterone (17 alpha-OHP4).
- Assessed ACTH and cortisol circadian rhythms, ovine CRH (oCRH) and cosyntropin stimulation tests in stage IVC patients.
Main Results:
- Elevated mean serum cortisol in stage IVC and progesterone in both stages compared to controls.
- Significantly higher cortisol in stage IVC vs. II/III; higher 17 alpha-OHP4 in stage II/III vs. IVC.
- Normal cosyntropin tests, but 63% of stage IVC patients had blunted oCRH responses; cortisol negatively correlated with CD4 cell count.
Conclusions:
- HIV infection is associated with altered adrenal hormone levels, particularly cortisol, which correlates inversely with CD4 cell count.
- While standard cosyntropin stimulation tests may appear normal, the hypothalamic-pituitary-adrenal (HPA) axis may show dysfunction, as indicated by abnormal oCRH testing in advanced HIV disease.