Low Adrenal Androgens in Men with HIV Infection and the Acquired Immunodeficiency Syndrome

Abstract

Using gas chromatography and mass spectrometry we have studied the ratios of steroid metabolites and 24-hour urinary steroid excretion rates in 37 men of whom 14 where positive for the human immunodeficiency virus (HIV; group A), while 9 had acquired immunodeficiency syndrome (AIDS; group B). Controls were sick non-AIDS patients admitted to an intensive care unit (ICU) and healthy volunteers. In groups A and B and the ICU controls, there was a reduction in the excretion of adrenal androgen metabolites and a reduced ratio of 5α to 5β androgen metabolites. These data suggest that adrenal androgens are removed in HIV and AIDS in a similar manner to other systemic illnesses. In group B patients and the sick controls, the ratios of cortisol to cortisone metabolites were raised compared with controls. Daily, total cortisol metabolite excretion rates in AIDS were similar to those in patients in the ICU. The selective loss of adrenal androgens may be mediated by cytokines and influence components of the immune system. The progression of HIV to AIDS may be due in part to an imbalance between androgens and glucocorticoids.

A Review of Hypogonadism and Erectile Dysfunction Among HIV-Infected Men During the Pre- and Post-HAART Eras: Diagnosis, Pathogenesis, and Management

“…33,[39][40][41] In addition to the low production of testosterone by the Leydig cells, shunting from androgen production to cortisol secretion by the adrenal glands has been demonstrated. 33,35,37,42 Opportunistic infections were also frequently encountered in the pre-HAART era; cases of toxoplasmosis, cytomegalovirus, Mycobacterium avium intracellulare, Cryptococcus neoformans, and Histoplasma capsulatum causing primary (testicular) and/or secondary (hypothalamus/pituitary) hypogonadism were reported. [43][44][45][46][47][48][49][50] HIV-associated malignancies such as Kaposi's sarcoma and lymphoma were also implicated.…”

Diagnosis and Treatment of Androgen Deficiency in Human Immunodeficiency Virus–Infected Men and Women

“…HIV infection can also result in decreased adrenal androgen secretion, with shunting of adrenal androgen metabolism to at Rutgers University Libraries/Technical Services on April 10, 2015 http://cid.oxfordjournals.org/ Downloaded from cortisol secretion [20], similar to that observed among patients with systemic illness who are hospitalized in an intensive care unit [21].…”

Fatigue-Related Gene Networks Identified in CD14+ Cells Isolated From HIV-Infected Patients—Part I

“…Hallmarks of progressive HIV disease include symptoms such as persistent fatigue, loss of muscle mass, loss of sexual function, and many other testosterone driven disorders. SULT2B1 is a key gene in androgen synthesis pathways, and investigators have identified gonadal and adrenal androgen deficiencies in people living with HIV disease (Croxson et al, 1989; Honour, Schneider, & Miller, 1995). Testosterone-replacement therapies have improved fatigue in men living with HIV (Rabkin, Wagner, McElhiney, Rabkin, & Lin, 2004).…”