Endocrine Abstracts

Since the advent of effective combined antiretroviral therapy (ART), mortality due to HIV disease has significantly declined. Changing trends in HIV-associated morbidity is surfacing, firstly due to the effect of HIV on virtually every human organ system and secondly due to improved life expectancy and consequent development of natural co-morbid illnesses. HIV associated endocrinopathies and metabolic diseases pose a significant disease burden in these patients. We discuss three patients with HIV infection, well controlled on ART, presenting with diverse endocrine involvement.

Young woman on ART presents with non-specific aches. Vitamin D deficiency and Tenofovir use known to affect bone mineral density (BMD) resulted in a DEXA bone scan, which showed T-score at −1.5. Vitamin D replacement and change to bone-friendly Abacavir stabilised the BMD at 18 months.

Middle-aged man on ART has triglyceride levels of 45 (0.8–1.8 mmol/l) and lipemic serum. Patient’s poor life-style factors were addressed and started on statins with good improvement in lipids. ART-related dyslipidemia is difficult to treat; life-style measures and modification of ART along with lipid-lowering drugs are important.

Middle-aged man previously well controlled on ART has unexplained drop in CD4 counts. This prompted several investigations including random cortisol, which was low. A short Synacthen test confirmed adrenocortical deficiency. Other pituitary axes and MRI scan of pituitary were normal. He is now on hydrocortisone replacement.

HIV associated endocrine/metabolic dysfunction, causing adverse bone metabolism, adrenal insufficiency, lipodystrophy, insulin resistance, and dyslipidaemia, has heterogeneous mechanism and pathogenesis. HIV itself and opportunistic infections can directly affect endocrine organs. Endocrine gland infiltration by lymphoma and Kaposi’s sarcoma is also recognised. ART is also implicated in metabolic dysfunction, mitochondrial toxicity being a key mechanism. Physicians caring for these patients should be vigilant in identifying and managing these in a timely manner to limit the associated morbidity.