Endocrine disorders in people with HIV infection

Katherine Samaras1,2,3 

  1. St Vincent’s Clinical School, University of New South Wales, Sydney, NSW
  2. Department of Endocrinology, St Vincent’s Hospital, Sydney, NSW.
  3. Garvan Institute of Medical Research, Sydney, NSW

Introduction

Endocrine conditions occur commonly in HIV infection, due to specific effects of the virus, HIV-related disease, the effects of reconstitution of the immune system after the commencement of combination antiretroviral therapy (cART), complications of cART, or drug-drug interactions (Table 1).

Table 1. Endocrine disorders due to effects of HIV, HIV-related disease, immune reconstitution and drug therapy

Direct HIV-1 virus effects

HIV-related disease

Immune reconstitution

Drug effects

Adrenal disease

Adrenalitis (rare)

Infections: CMV

Toxoplasmosis

Mycobacterial

Malignancy: KS

Addison’s disease (rare)

Reduced corticosteroid synthesis: antifungals (ketoconazole)

Pituitary suppression: cytochrome P450 3A4 drug interactions with inhaled or oral steroids

Thyroid disease

Graves’ disease

Hashimoto’s hypothyroidism

Interferon-induced thyroid disease

Diabetes mellitus

-

Pentamidine-induced insulin deficiency (T1D)

Insulin resistance due to protease inhibitors and NRTIs (T2D)

Calcium metabolism

Osteoporosis

NRTI-related osteroporosis

Sex hormones

Androgen deficiency

Androgen deficiency