Abstract
The occurrence of endocrine diseases in people who are infected with HIV is traditionally thought to occur in the setting of AIDS with opportunistic infections and malignancies. However, recent studies find the correlation between hypocortisolism and stage of HIV (CD4 count and WHO clinical stage) inconsistent. This descriptive cross-sectional study included three hundred and fifty (350) consecutive patients with HIV infection. They were interviewed, and subsequently underwent laboratory evaluation for the detection of hypocortisolism. Blood samples for serum cortisol estimation were taken at baseline and at 30 minutes following the administration of 1µg of tetracosactrin (Synacthen). In addition, the patients had blood samples taken at 0 minutes (baseline) for CD4+ lymphocyte cell counts. At baseline, 108 (30.9%) participants had serum cortisol levels below 100 µg/L with a median value of 55.48 µg/L (11.36-99.96 µg/L), but only 57 (16.3%) study participants had stimulated serum cortisol levels below 180 µg/L with median of 118 µg/L (19.43-179.62). There was no significant difference in the occurrence of clinical features between participants with low and normal serum cortisol, nor WHO clinical stage, CD4 count and ART regimen. The occurrence of hypocortisolism was higher among participants who had been on ART for a longer period of time. There is a high prevalence of hypocortisolism among HIV patients by biochemical testing, especially those who have been on ARVs for a longer duration. Hypocortisolism cannot be predicted based on the participants' WHO clinical stage of disease, CD4 cell count, or the treatment regimen. Personal Funds.
Highlights
The human immunodeficiency virus type-1 (HIV-1) infection and its sequelae, the acquired immune deficiency syndrome (AIDS) are major causes of morbidity and mortality worldwide, accounting for over 35 million deaths.[1]
The aim of this study was to evaluate the occurrence of hypocortisolism among HIV patients, and determine the relationship between hypocortisolism, the clinical stage of HIV, the CD4 count and the ART regimen of patients who were attending the HIV clinic at the Aminu Kano Teaching Hospital (AKTH), Kano
Blood samples for serum cortisol estimation were taken at baseline and at 30 minutes following the administration of 1μg of tetracosactrin (Synacthen)
Summary
The human immunodeficiency virus type-1 (HIV-1) infection and its sequelae, the acquired immune deficiency syndrome (AIDS) are major causes of morbidity and mortality worldwide, accounting for over 35 million deaths.[1] Endocrine diseases, including dyslipidemia, disorders of bone homeostasis, and dysfunction of the adrenal, gonadal, and thyroid axes were reported in HIV-infected persons early in the HIV epidemic prior to the availability of HAART.[2] The occurrence of endocrine diseases in people who are infected with HIV is traditionally thought to occur in the setting of AIDS with opportunistic infections and malignancies.[3, 4]. Even in the setting of sustained treatment of HIV infection with highly active anti-retroviral therapy (HAART) and a fully suppressed HIV RNA, there is an associated heightened systemic inflammation and immune dysfunction, albeit at lower levels than without antiretroviral treatment.[5] This state of persistently heightened inflammation may account for certain endocrine and cardiovascular complications of HIV.[6]. Adrenal diseases are thought to be the commonest endocrine abnormality in HIV, with autopsy studies showing involvement of the adrenal glands in 40-90% of patients who have AIDS.[3,4,7] www.ghanamedj.org Volume 52 Number 3 September 2018
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