HYPOTHALAMO-PITUITARY-ADRENAL FUNCTION IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED MEN

We prospectively studied adrenal function in 51 human immunodeficiency virus-positive male patients, including heterosexuals, homosexuals, a nd iv drug users, classified according to 1987 CDC criteria as belongi ng to stages II/III or IVC. Basal serum concentrations of cortisol (F) , progesterone (P-4) and 17 alpha-hydroxyprogesterone (17 alpha-OPH4) were determined during the two stages. In stage IVC patients, the circ adian rhythms of ACTH and F were assessed, and ovine CRH (oCRH) and im mediate cosyntropin-stimulating tests were evaluated. Serum concentrat ions of hormones were analyzed in relationship to the absolute CD4 cel l count in all subjects. The mean serum F concentration in stage IVC p atients, the mean P-4 concentration in stage II/III and IVC patients, and the mean 17 alpha-OHP4 level in stage II/III patients were signifi cantly increased compared to control values (P < 0.0001, P < 0.0001, a nd P < 0.002, respectively). The mean serum F concentration in stage I VC patients was significantly increased compared to that in stage II/I II patients (P < 0.004), and the mean serum 17 alpha-OHP4 concentratio n in stage II/III patients was significantly increased compared to tha t in stage IVC patients (P < 0.02). In the 22 stage IVC patients, the circadian rhythms of ACTH and F were normal in all but 7 for ACTH and 5 for F, whereas oCRH test results indicated that 14 of them had reduc ed or blunted responses. By contrast, cosyntropin stimulation results were normal. CD4 cell counts were significantly negatively correlated with the serum F concentration (P < 0.02). In conclusion, during human immunodeficiency virus infection, the serum F concentration was negat ively correlated with CD4 cell counts. Cosyntropin test results were n ormal, but 63% of the stage IVC men had abnormal responses to oCRH.