Correlation between increased cortisol : DHEA ratio and malnutrition in HIV-positive men

Malnutrition in HIV-infected patients is characterized by a loss of both fa t-free mass (FFM) and fat mass (FM). Glucocorticoids and androgens change d uring the course of the infection and may play a key role in the protein ba lance. The serum concentrations of cortisol, adrenal (DHEA and DHEA sulfate ) and gonadal androgens (androstenedione, testosterone, and dihydrotestoste rone) of HIV-positive men were measured and compared with several parameter s of body composition as a function of body weight loss (BWL). The patients were assigned to one of five groups according to their BWL: group I (contr ols, n = 10) <5%, group Il(n = 7) 5-10%, group III (n = 8) 10.1-16%, group TV (n = 9) 16.1-24%, and group V (n = 4) >24.1%. Correlation analysis showe d significant positive or negative relationships between several markers of malnutrition and adrenal androgens and the cortisol:DHEA ratio, but not wi th cortisol. BWL was negatively correlated with DHEA (I = -0.69, P < 0.0001 ), DHEA sulfate (r = -0.58, P < 0.0001) and testosterone (r = -0.34, P < 0. 03), but positively with the cortisol:DHEA ratio (r = 0.61, P < 0.0001). In contrast, BCM was positively correlated with DHEA (r = 0.34, P < 0.04) and DHEA sulfate (r = 0.36, P < 0.03) and negatively with the cortisol:DHEA ra tio (r = -0.58, P < 0.0001). The cortisol:DHEA ratio was also negatively co rrelated with BMT (body mass index) (r = -0.56, P < 0.01), fat-free mass (r = -0.48, P < 0.004), fat mass (r = -0.39, P < 0.02), and BCM:weight ratio (I = -0.47, P < 0.005) and positively with the extracellular:intracellular water ratio (r = 0.54, P < 0.001). These data indicate that the steroid hor mone environment of patients, particularly their cortisol:DHEA ratio, is li nked to the malnutrition associated with HIV infection. The decreased DHEA and increased cortisol in patients with the advanced stages of disease coul d be associated with increased protein catabolism. (C) Elsevier Science Inc .