The progression of HIV infection is accompanied by severe immunodepres
sion and cachexia, particularly during advanced stages. The immune dep
ression is due largely to a dramatic drop in the number of CD4 cells.
The loss of body weight is mainly due to a reduced fat-free mass with
no change in adipose tissue. We determined the serum concentrations of
cortisol and DHEA and their correlations with absolute CD4 cell count
s and changes in body weight of HIV-positive men. The results of five
retrospective and prospective studies indicate that the serum concentr
ations of cortisol and DHEA in HIV-infected patients were different fr
om those of HIV-negative controls. Serum cortisol was elevated at all
stages of infection (+20 to +50%, p<.05 to p<.001) particularly in AID
S patients (stage IV C). In contrast, the serum DHEA concentrations we
re closely correlated with the stage of HIV-infection, being higher in
the early stages (stages II and III or >500 CD4) than in advanced sta
ges (IV C or <500 CD4)-in the latter being below those of HIV-negative
men-or in controls (+40 to 100%, p<.01 to p<.001). There was a negati
ve linear correlation between the CD4 cell counts and cortisol (r=-0.4
, p<.02) and a positive linear correlation with DHEA (r=+0.36, p<.01).
There was no significant correlation between Delta body weight and se
rum cortisol. In contrast, there was a negative correlation between se
rum DHEA and Delta body weight (%) (r=-0.69, p<.0001) and a positive c
orrelation with the cortisol/DHEA ratio (r=+0.61, p<.0001). There is t
hus a link between the circulating concentrations of adrenal steroids
and the progression of immunosuppression and cachexia during HIV-infec
tion. This mises the question of whether there is a cause-and-effect r
elationship between clinical progression and circulating steroid conce
ntrations. Further investigations into the relationship between the ra
tio cortisol/DHEA and the immune response and cachexia should indicate
the contributions of these steroids to the etiology of HIV infection
and lead to the development of new therapeutic strategies. (C) 1997 El
sevier Science Ltd.