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Adrenal Function in the Human Immunodeficiency Virus–Infected Patient
Jose Mayo, MD;
Julio Collazos, MD;
Eduardo Martínez, MD;
Sofía Ibarra, MD
Arch Intern Med. 2002;162:1095-1098.
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 TH1 to TH2 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.
From the Section of Infectious Diseases, Hospital de Galdakao, Vizcaya,
Spain.
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