Adrenal Function in the Human Immunodeficiency Virus–Infected Patient

Abstract

Although clinical manifestations of adrenal dysfunction are uncommon in patients infected with human immunodeficiency virus (HIV), subclinical functional abnormalities of the hypothalamic-pituitary-adrenal axis are frequent. Patients infected with HIV usually have higher basal serum cortisol and lower serum dehydroepiandrosterone concentrations than HIV-seronegative individuals. This imbalance has been related to progression of the infection by inducing a shift from T(H)1 to T(H)2 immunologic responses. Although, adrenal reserve may be marginal in HIV-infected patients, clinically evident adrenal insufficiency is uncommon and, when present, it is observed in advanced stages of the infection. Hypocortisolemia should be treated regardless of the existence of associated symptoms. On the contrary, hypercortisolemia in the absence of features of Cushing syndrome is common and should not promote treatment nor specific studies. The possible influence that alterations of the adrenal function could have on the patients' immune status and the eventual effect of antiretrovirals on these alterations merit further investigation.

Cortisol Response Mediates HIV-1-Related Cognitive Deficits Among Injecting Drug Abusers

“…Our findings show similar results since the mHDS also measures declarative verbal memory. Glucocorticoid (GC) levels (reflected by cortisol levels in humans) are elevated for prolonged periods in HIV-1 infection [21] . Given the close significant relation between cortisol response to stress, HIV serostatus and cognitive function, the findings from the present study present suggestive parallels to these previous findings.…”

Antiretroviral therapy outcome in human immuno-deficiency virus infected patients in a tertiary care hospital

“…Mortality could be further avoided by monitoring those with advanced disease as they start ART, and it raises the possibility that early mortality could also be due to undiagnosed opportunistic infections, nutritional deficiencies, or severe immune reconstitution inflammatory syndrome, although there is no direct evidence to support these possible reasons. [23][24][25] This study showed reduced early mortality as patients who attended the clinic were diagnosed quickly and were counselled to start ART before they become wasted and anemic. 6 Though the stigma associated with the disease prevent patients from seeking early treatment, the free provision of drugs by government ART centres has encouraged people to seek medical attention earlier, as has been observed in the United States and other developed countries.…”

Clinical and Pre-clinical Applications of the Transcendental Meditation Program® in the Prevention and Treatment of Essential Hypertension and Cardiovascular Disease in Youth and Adults

“…However, chronic stress causes cortisol overproduction, resulting in damaging effects. There is evidence that elevated cortisol levels or impaired cortisol regulation increases atherosclerosis [127], hypertension [128], cancer [129], obesity [130], osteoporosis [131], immunodeficiency [132], hyperlipidemia [133,134], depression [135], some anxiety [136] and aggression-related disorders, such as drug abuse and other addictive disorders [137]. TM practice has been shown to produce a healthy cortisol profile of lower baseline levels and a more robust cortisol response to acute stress.…”