Indan Journal of Medical Research Indan Journal of Medical Research Indan Journal of Medical Research Indan Journal of Medical Research
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ORIGINAL ARTICLE
Year : 2018  |  Volume : 147  |  Issue : 2  |  Page : 142-150

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


1 Department of Biochemistry, Post Graduate Institute of Medical Education & Research & Dr Ram Manohar Lohia Hospital, New Delhi, India
2 Anti-Retroviral Therapy Clinic, Post Graduate Institute of Medical Education & Research & Dr Ram Manohar Lohia Hospital, New Delhi, India
3 Post Graduate Institute of Medical Education & Research & Dr Ram Manohar Lohia Hospital, New Delhi, India
4 Department of Endocrinology, Post Graduate Institute of Medical Education & Research & Dr Ram Manohar Lohia Hospital, New Delhi, India

Correspondence Address:
Dr Deep Dutta
Department of Endocrinology, Post Graduate Institute of Medical Education & Research & Dr Ram Manohar Lohia Hospital, 1 Baba Kharak Singh Marg, New Delhi 110 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_43_16

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Background & objectives: Adrenal insufficiency (AI) is rarely diagnosed in patients with HIV infection, in spite of autopsy studies showing very high rates of adrenal involvement. This study was aimed to determine the presence, patterns and predictors of AI in patients with HIV infection. Methods: Consecutive HIV patients, 18-70 yr age, without any severe co-morbid state, having at least one-year follow up at the antiretroviral therapy clinic, underwent clinical assessment and hormone assays. Results: From initially screened 527 patients, 359 patients having good immune function were analyzed. Basal morning cortisol <6 μg/dl (<165 nmol/l; Group 1), 6-11 μg/dl (165-300 nmol/l; Group 2), 11-18 μg/dl (300-500 nmol/l; Group 3) and ≥18 μg/dl (500 nmol/l; Group 4) were observed in 13, 71, 199 and 76 patients, respectively. Adrenocorticotropic hormone (ACTH) stimulation test revealed 87 patients (24.23%) to have AI. AI in groups 1-4 was 100, 56.34, 17.09 and 0 per cent, respectively. AI patients were more likely to be females (P<0.05), having longer disease duration (P<0.05), immune reconstitution inflammatory syndrome, hyperkalaemia (P<0.01), lower fasting glucose (P<0.01), dehydroepiandrosterone sulphate (DHEAS) and vitamin D. Regression analysis revealed morning cortisol and DHEAS to be best predictors of AI (P=0.004 and 0.028, respectively). Interpretation & conclusions: AI is a significant problem in HIV-infected individuals, observed in nearly a quarter of patients. Diagnosis warrants high index of suspicion and low threshold for screening, especially in those having low DHEAS and hyperkalaemia. Morning cortisol is a reasonable screening test, with ACTH stimulation warranted to confirm diagnosis, especially in patients with morning cortisol <11 μg/dl (300 nmol/l).


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