ACTH AND CORTISOL SECRETIONS IN CHILDREN WITH PERINATAL HIV-1 INFECTION

Serum cortisol and adrenocorticotropic hormone (ACTH) values and CD4 c ell count were evaluated in 25 perinatally HIV-1-infected children. Th e children were divided into three groups: group 1 included eight asym ptomatic or paucisymptomatic children, group 2 nine moderately symptom atic children, and group 3 eight children with severe clinical manifes tations. Group 1 children were without antiretroviral therapy; the rem aining children received zidovudine (AZT) treatment. Only one group 3 patient had primary adrenal insufficiency. No significant differences in cortisol and ACTH secretion were found either between all HIV-1-inf ected and 126 age- and sex-matched normal children or among the three groups of patients. Mean CD4 cell count of each group declined in para llel to disease progression. No correlations were found between cortis ol or ACTH values and CD4 cell count. Adrenal failure may be a late co mplication of HIV-1 infection and should be searched for in severely i ll patients. Our data argue against the hypothesis of a cortisol-induc ed shift from T-helper-1 (Th1) to Th2 cytokine production profile as t he pathogenetic mechanism of progression to AIDS.