Basal Cortisol Levels and Correlates of Hypoadrenalism in Patients with Human Immunodeficiency Virus Infection

Abstract

Objective: To determine the frequency of occurrence of hypoadrenalism in patients with human immunodeficiency virus (HIV) infection and document the clinical correlates of hypoadrenalism for this group of patients. Subjects and Methods: A descriptive study was carried out on 66 hospitalized HIV patients in a semi-urban setting of South Africa. Hypoadrenalism was diagnosed based on a basal cortisol level of less than 400 nmol/l with or without overt signs and symptoms. Clinical and biochemical parameters of hypoadrenalism were compared between subjects with suboptimal and normal cortisol levels. Statistical analysis included Student’s t test, χ² and Pearson’s correlation coefficient tests. Results: The prevalence of hypoadrenalism was 27% with a high occurrence of contributory factors (cytomegalovirus infection in 100% and tuberculosis in 68.2% of the study subjects). Typical features of hypoadrenalism included: hyponatremia, 19.6%; hyperkalemia, 6.1%; mucosal hyperpigmentation, 12%, and loss of axillary hair, 15%. Comparison of clinical and biochemical parameters of hypoadrenalism did not show a correlation between CD4 count and cortisol levels (r = 0.1 and p = 0.3). Conclusion: The prevalence of hypoadrenalism in our patients with HIV infection was high and the clinical features were comparable in subjects with normal and subnormal cortisol levels.

Correlation of baseline hormonal disorders with immunological failure and mortality in male HIV patients during follow-up

“…The finding of an increase in plasma cortisol and a decrease in DHEA-S levels implies that they are important indicators for the progressive decline in immune system function during HIV infection. [19] However, we did not find any correlation between cortisol levels and CD4+ T cell counts, which agrees with findings reported by Ekpebegh et al [20] High cortisol levels could be explained by severe stress, [21,22] decreased cortisol catabolism, [23] and alterations in the concentrations or properties of corticosteroid-binding globulin in HIV-infected patients. [24] In our study, high cortisol levels could not predict immunological failure but could be a sensitive predictive marker for mortality.…”

Presence, patterns & predictors of hypocortisolism in patients with HIV infection in India

“…Sample size calculation : The prevalence of AI among HIV patients in India is not known. However, studies done in South Africa and Nigeria have shown 27.5 and 34.5 per cent of HIV positive patients had AI, respectively 8 9 . Keeping a power of 80 per cent and Type-I error at 5 per cent, a sample size of 246 patients was required in our study for accurate assessment of hypoadrenalism.…”

“…AI was seen in 24.23 per cent patients, which was comparable to previous reports from other parts of the globe. Studies from Brazil, Uganda, South Africa and Nigeria have reported the prevalence of AI ranging from 19 to 34.5 per cent 8 9 20 21 . In a small study of critically ill AIDS patients with advanced disease from southern India (n=50), AI was diagnosed in 74 per cent patients using ACTH stimulation test 22 , which was much higher than that in this report.…”

“…Autopsy studies have demonstrated adrenal involvement in 40-90 per cent of HIV-infected patients 7 . Studies from Africa have consistently demonstrated a high prevalence of adrenal insufficiency (AI) in HIV-infected patients ranging from 27.5 to 34.5 per cent 8 9 . However, AI/hypocortisolism is rarely diagnosed in routine clinical practice in patients with HIV infection in India.…”

Human Cytomegalovirus (HCMV) Infection in Sub-Saharan Africa

“…The most common presentation of HCMV infection in HIV-infected patients is HCMV pneumonia, where co-infection with other respiratory pathogens such a tuberculosis and Pneumocystis jirovecci, is almost ubiquitous [50,60]. HCMV is an important HIV co-infection, also linked with a range diseases including meningitis [62], encephalitis [63], psychological disorders [64], malaria [65], various dermatological conditions [66,67] and those affecting mucosal epithelia [68,69], hypoadrenalism [70], adrenalitis [71], gastritis [72,73] and other herpesvirus infections [74]. There has been a huge (possibly disproportionate) focus on HCMV as a cause of HIV-associated retinitis.…”