How best to approach endocrine evaluation in patients with HIV in the era of combined antiretroviral therapy?
Wren A. Clin Endocrinol (Oxf). 2013 Jun 24. doi: 10.1111/cen.12269. [Epub ahead of print]


Chelsea and Westminster Hospital - Endocrinology, 369 Fulham Road London, sw10 9nh, United Kingdom.


Endocrine and metabolic dysfunction has been documented throughout the history of clinical experience with HIV and AIDS. Opportunistic infections such as CMV and TB adrenalitis, tumours affecting endocrine organs and cachexia and wasting can still be seen, particulary in severely immunocompromised individuals who may be non-compliant with, resistant to, or without access to effective anti-retroviral therapy. However, in those with good control of their HIV infection, the profile of endocrinopathy in HIV has largely changed with the advent of highly effective combination antiretroviral therapy. The problems that we now more frequently see in people living for many years with low viral loads and good CD4 counts, relate to side effects or interactions of therapy. These included adverse metabolic effects of anti-retrovirals, most notably dylipidaemia and lipodystrophy with protease inhibitors, drug-drug interactions, including marked CYP3A4 inhibition with protease inhibitors and autoimmune endocrinopathy as part of an immune reconstitution syndrome after initiation of anti-retrovirals. In addition chronic endocrine and metabolic disorders, including hypogonadism and osteoporosis, occur at higher levels than in the background population, associated with chronic illness, lower body weight and use of both prescribed and non-prescribed drugs. This article is protected by copyright. All rights reserved.