Abstract

Aim: To find Prevalence, Aetiology and Clinical Spectrum of abnormal adrenal functions in Human Immunodeficiency Virus infection. To diagnose and treat adrenal dysfunction in various stages of HIV infection and see the response to treatment if required.

Material & Methods: 100 patients with HIV infection being admitted to our hospital was evaluated for abnormal adreno cortical functions. Immune dysfunction was assessed with CD4 count. Statistical tests (chi squared test) were applied to the collected data to find out any significant correlations.

Results: The overall prevalence of adrenocortical abnormalities in HIV positive patients was 14% which included hypocortisolemia in 3% and hypercortisolemia in 11% of patients. Frequency of hypocortisolemia was significantly associated with presence of HIV infection with opportunistic infections and low CD4 counts (less than 50cells). In patients having hypercortisolemia, ONDST (Over night dexamethasone suppression test) was done and it showed reduction of serum cortisol to expected level (suppressed to <1.8 mcg/dl). Adjustment disorders and drugs mainly efavirnz more than nevirapine was incriminated in the same.

Conclusion: HPA axis dysfunction is frequently encountered in HIV infected patients. The commonest dysfunction was hypercortisolemia probably due to elevated cytokines. Hypercortisolemia is a feature of early stage HIV infection. The likelihood of adrenal insufficiency increases as the disease advances and patient enters a more immunocompromised state. Hypocortisolemia should be treated regardless of the existence of associated symptoms. Hypercortisolemia in the absence of features of Cushing’s syndrome is common and should not promote treatment or specific studies.