Endocrine and Metabolic Disorders Associated with Human Immune Deficiency Virus Infection (original) (raw)
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Endocrine and Metabolic Manifestations of HIV Infection and AIDS
Journal of Intensive Care Medicine, 2001
Rosenfeld CR, Reddy SSK. Endocrine and metabolic manifesta-Since the initial description of AIDS nearly two dections of HIV infection and AIDS. J Intensive Care Med 2001;16: ades ago, there has been a growing body of infor-161-168. mation on the effects of HIV on the endocrine sys-Since the first descriptions of acquired immune deficiency tem. While some of these effects can be viewed as syndrome (AIDS) and human immunodeficiency virus (HIV), similar to those in any patient with acute or chronic a great deal of knowledge has been accumulated on how illness, differences may exist, particularly in adrenal these entities interact with the endocrine system. Recently and thyroid function. Beginning with pathologic new information has been received on autoimmune dysregulation causing thyroid abnormalities after highly active studies published in the mid-1980s, continuing on antiretroviral therapy (HAART), as well as metabolic dysreguto the pathophysiology data accumulated in the lation occurring in the setting of protease inhibitors. We late-1980s and early 1990s, and bringing medical review the pathophysiologic abnormalities of the endocrine knowledge into the new millennium with the metasystems due to HIV infection as well as the endocrine effects bolic effects of some of the newer agents used to of drugs commonly used in HIV management. The spectrum of endocrine dysfunction associated with HIV is growing treat HIV infection, we will review the controversies and the intensive care physician must be aware of these surrounding how HIV infection affects the endopotentially reversible abnormalities. crine system (Table 1). Adrenal Pathologic involvement of the adrenal gland is observed in 49-92% of HIV patients at autopsy [1-6]. Observed changes have been attributed to infection, neoplastic replacement, hemorrhage, and cortical lipid depletion. The histopathology ranges from focal inflammation to extensive hemorrhagic necrosis. In most cases, less than 50% cortical necrosis is noted, much less than the 80-90% destruction required for clinically evident adrenal insufficiency [2,7]. Unfortunately adrenocorticotropic hormone (ACTH) stimulation testing appears to be rarely performed and a great deal of the clinical findings (i.e., hyponatremia, hypotension, hyperkalemia) can be explained by severe infection, gastrointestinal losses, or concomitant medications. In most cases, the adrenal abnormalities were detected postmortem. Of all infections affecting the adrenal gland, cytomegalovirus (CMV) is the most common. The From the Department of Endocrinology, Diabetes, and Metaboadrenal glands are the most common site of extralism, Cleveland Clinic Foundation, Cleveland, OH.
Endocrinopathies in Hiv Infected Patients
Journal of Clinical and Health Sciences
Introduction: Hormonal abnormality is one of many clinical manifestations of HIV infections that is not well understood. However, the consequences could affect quality of life and are potentially treatable. Thus, this study aimed to determine the prevalence and associated factors of thyroid, adrenal and gonadal dysfunctions among HIV-infected patients. Methods: This is a single centre cross-sectional study involving 150 HIV-infected patients attending the HIV clinic. Each subject was required to answer specific symptoms questionnaire and their medical records were reviewed for relevant clinical and biochemical data. Blood for was collected and thyroid hormones, cortisol, ACTH, FSH, LH, testosterone and estradiol were analysed using electrochemiluminescent immunoassay. Thyroid, adrenal and gonadal axes abnormalities were identified. Results: Hypogonadism had the highest prevalence amongst the endocrine abnormalities, which was detected in 23 patients (15.3%), followed by thyroid dysf...
Chapter 37. Endocrine Disorders in HIV/AIDS
GENERAL PRINCIPLES • Acquired immunodeficiency syndrome (AIDS) is caused by the human immunodeficiency virus (HIV), which is transmitted by exchange of infected blood, semen, or vaginal secretions through mucosal membranes. HIV targets CD4+ T lymphocytes, where it integrates into the host DNA, replicates, and produces new virions that infect and reduce T-cell number. This weakens host immunity and renders the host susceptible to common pathogens [1]. • Currently, there is no vaccine or cure for HIV. However, since the mid-1990s the use of highly active antiretroviral therapy (HAART) has reduced HIV-related morbidity and mortality so effectively that HIV infection is now considered a chronic manageable infection [1]. • HIV infection and HAART are associated with several endocrine, metabolic, anthropomorphic, and cardiovascular complications. • All patients with HIV infection are at risk for endocrine disorders. Reasons include: increased inflammation (HIV replication, obesity), AIDS wasting, presence of opportunistic infections, HAART toxicities, immune reconstitution syndrome, genetic risk and traditional environmental factors [2]. • In general, the signs and symptoms of endocrine disorders in patients with HIV infection do not differ from those observed in immunocompetent individuals. Please refer to the previous chapters for specific examples of presentations for each given disorder.
Metabolic disorders and chronic viral disease: The case of HIV and HCV
Diabetes & Metabolism, 2009
The importance of metabolic disorders in the pathophysiology of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections is becoming increasingly apparent. Metabolic anomalies, with their potential for multiple-organ involvement, are to be expected, given the chronic nature of these diseases, and the intracellular dysregulation associated with them. Not only have the endocrine and cytokine metabolic anomalies seen in HIV and HCV infections been linked with the metabolic syndrome, but they also appear to have some pathways in common. Studying the differences and similarities between these metabolic anomalies may add to our understanding of HIV and HCV infection, and provide guidance on how to treat these chronic diseases. This review highlights the principal underlying factors for metabolic disorders in these chronic viral diseases-namely insulin resistance and liver damage. Both the chronic viral state itself and the host immune response give rise to glucose and lipid metabolic disorders that, in turn, are risk factors for hepatic damage. The various interactions between HIV and/or HCV with insulin resistance, type 2 diabetes, steatosis and fibrogenesis should be considered when determining the treatment and long-term follow-up of patients. Recent data indicate that HCV clearance improves insulin resistance and hepatic function in HCV-infected patients treated with interferon with or without ribavirin.
Endocrine changes in male HIV patients
The Journal of the Association of Physicians of India, 2011
To determine the frequency of adrenal, thyroid and gonadal dysfunction in HIV positive male patients and to evaluate the endocrine function at different level of CD4 cell counts. A total of 150 male HIV positive subjects were included in study. The patients were divided in three groups on the basis of CD4 cell counts. "Group A": HIV positive with CD4 count<200/mm "Group B": HIV positive with CD4 count 200-350/mm3 and "Group C": HIV positive with CD4 count>350/mm3. In "group A" (n=50) 2 patients had basal cortisol<5 microg/dl while 23 patients had basal cortisol>25 microg/ dl. 15 patients had subclinical hypothyroidism while 11 patients had overt hypothyroidism. 25 patients in this group had gonadal dysfunction: majority of them (24) had primary gonadal dysfunction (elevated LH). None of the patients in "group B" (n=50) had hypocortisolism while 11 patients had elevated cortisol; 18 had…
Disease and diagnosis, 2022
Background: Since the beginning of the acquired immunodeficiency syndrome (AIDS) pandemic, the number of people infected with human immunodeficiency virus (HIV) has shown a steady increase. Previous evidence exists regarding the evaluation of endocrine dysfunction in HIV-infected individuals. The present study sought to investigate the prevalence of metabolic and endocrine disorders in HIV-positive patients. Materials and Methods: In this cross-sectional study, 72 HIV-positive patients supported by the Behavioral Diseases Center of Bandar Abbas, Iran were recruited from April, 2016 to September, 2017. Patients who did not consent to participate were excluded from the study. Several parameters were measured, including serum free T3, free T4, thyroid-stimulating hormone (TSH), luteinizing hormone (LH), adrenocorticotropic hormone (ACTH), free testosterone, cortisol, fasting plasma glucose (FPG), 2-hour plasma glucose, cholesterol, triglyceride, and low-and high-density lipoprotein levels. Finally, data were analyzed using chi-square and Mann-Whitney tests. Results: High serum lipoprotein levels, diabetes, and prediabetes were observed in 28/72 (38.9%), 13/72 (18.1%), and 17/72 (23.6%) patients, respectively. The prevalence of overt hypothyroidism and subclinical hypothyroidism, as well as overt hyperthyroidism and subclinical hyperthyroidism was 32.8% (22/67), 9% (6/67), 1.5% (1/67), and 7.5% (5/67), respectively. Primary and secondary gonadal dysfunction were found in 1/47 (2.1%) and 9/47 (19.1%) patients, respectively. Primary and secondary adrenal insufficiency were detected in 8/53 (15.1%) and 1/53 (1.9%) patients, respectively. Diabetes was significantly more frequent among older patients and those with a history of addiction. Conclusions: The results of this study indicated a relatively high frequency of metabolic and endocrine disorders, especially dyslipidemia and hypothyroidism in HIV-positive patients.
European Journal of …, 2011
Objective GH secretion is impaired in lipodystrophic Human Immunodeficiency Virus (HIV) patients and inversely related to lipodystrophy-related fat redistribution in men. Less is known about the underlying mechanisms involved in reduced GH secretion in HIV-infected women. Design A casecontrol, cross-sectional study comparing GH/IGF-1 status, body composition and metabolic parameters in 92 non-obese women with HIV-related lipodystrophy and 63 healthy controls matched for age, ethnicity, sex, and BMI. Methods GH, IGF-1, IGFBP-3, GH after GHRH+Arg, several metabolic variables and body composition were evaluated. Results GH response to GHRH+Arg was lower in HIV-infected females than in controls. Using a cutoff of peak GH <7.5 µg/L 20.6% of HIVinfected females demonstrated reduced peak GH responseafter GHRH+Arg. In contrast none of the control subjects demonstrated a peak GH response <7.5 µg/L. Bone mineral density (BMD), quality of life, IGF-1 and Insulin-Growth-Factor-Binding Protein 3 (IGFBP-3) were lowest in the HIV-infected females with a GH peak < 7.5 µg/L. BMI was the main predictive factor of GH peak in stepwise multiregression analysis, followed by age, with a less significant effect of visceral fat in the HIVinfected females. Conclusions This study establishes that (i) GH response to GHRH+Arg is lower in lipoatrophic HIV-infected women than in healthy matched controls, (ii) BMI more than VAT or trunk fat influences GH peak in this population, and (iii) HIV-infected women with a GH peak below or equal to 7.5 µg/L demonstrate reduced IGF-1, IGFBP-3, BMD and quality of life.
Human immune deficiency virus (HIV) infection and the hypothalamic pituitary adrenal axis
Reviews in Endocrine and Metabolic Disorders, 2013
The hypothalamic pituitary adrenal (HPA) axis is the most common of the endocrine lines/axis' to be affected by HIV infection. There are multiple factors that contribute to this HPA axis dysregulation. Direct invasion of the various organs in the axis can be either by opportunistic infections or infiltrative diseases. The soluble factors or cytokines released during viral infection and the chronic inflammatory state that follows, also contribute to these alterations. The actions of these cytokines released by the immune response can both activate the HPA axis and cause a glucocorticoid resistant state. Further, many of the anti-retroviral and other medications used to treat HIV infection can contribute to HPA axis dysfunction. While the diagnosis and treatment of endocrine dysfunction is the same as in any other patient, management pathways may be quite different. While some may be adaptive responses, life threatening adrenal insufficiency can also be present. It is important the latter be picked up expeditiously and treated promptly to avoid mortality.
Study on Endocrinological Profile of Hiv Infected Male Patients from Eastern India
International Research Journal of Pharmacy, 2013
Human Immunodeficiency virus (HIV) infectionis associated with a variety of endocrine problems. Hypoadrenalism, hypothyroidism and hypogonadism are commonly found singly or in combination. Especially, male hypogonadism is very common in this population and may lead to weight loss, lethargy and other co morbidities. We undertook this cross sectional observational study to evaluate endocrine profile in HIV infected males in a sample Eastern Indian population. We also studied for any correlation of the endocrine dysfunctions with their immune status. We studied the blood hormone profiles along with blood CD4 counts. The bloods were drawn in fasting state and analysed using suitable high sensitivity assays. Standard statistical methods were used. We had 48 patients in our study. Among them, 33% had hypogonadism, 20% had hypothyroidism and 15 patients had diabetes. The hypogonadism was mainly hypogonadotropic. In other studies across the globe also, hypogonadism in HIV positive males is found to be significant. Our diabetic patients were not on protease inhibitors. We found some patients who had multiple endocrine dysfunctions. HIV infection is often associated with endocrine abnormalities. This aspect of the disease must be addressed during routine care of these patients. Hormone replacement must be individualized and may be needed for prolonged periods.
European Journal of Endocrinology, 2012
Objective GH secretion is impaired in lipodystrophic Human Immunodeficiency Virus (HIV) patients and inversely related to lipodystrophy-related fat redistribution in men. Less is known about the underlying mechanisms involved in reduced GH secretion in HIV-infected women. Design A casecontrol, cross-sectional study comparing GH/IGF-1 status, body composition and metabolic parameters in 92 non-obese women with HIV-related lipodystrophy and 63 healthy controls matched for age, ethnicity, sex, and BMI. Methods GH, IGF-1, IGFBP-3, GH after GHRH+Arg, several metabolic variables and body composition were evaluated. Results GH response to GHRH+Arg was lower in HIV-infected females than in controls. Using a cutoff of peak GH <7.5 µg/L 20.6% of HIVinfected females demonstrated reduced peak GH responseafter GHRH+Arg. In contrast none of the control subjects demonstrated a peak GH response <7.5 µg/L. Bone mineral density (BMD), quality of life, IGF-1 and Insulin-Growth-Factor-Binding Protein 3 (IGFBP-3) were lowest in the HIV-infected females with a GH peak < 7.5 µg/L. BMI was the main predictive factor of GH peak in stepwise multiregression analysis, followed by age, with a less significant effect of visceral fat in the HIVinfected females. Conclusions This study establishes that (i) GH response to GHRH+Arg is lower in lipoatrophic HIV-infected women than in healthy matched controls, (ii) BMI more than VAT or trunk fat influences GH peak in this population, and (iii) HIV-infected women with a GH peak below or equal to 7.5 µg/L demonstrate reduced IGF-1, IGFBP-3, BMD and quality of life.