*Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA; †Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA; ‡Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA; §Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA; ‖Department of Pharmacy, Massachusetts General Hospital, Boston, MA; ¶Research Design Center/Biostatistics Research Center, Clinical and Translational Science Institute, Tufts University, Boston, MA; #Division of Endocrinology, Yale University School of Medicine, New Haven, CT; **Division of Endocrinology, Massachusetts General Hospital, Boston, MA; ††Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA; ‡‡Harvard University Center for AIDS Research, Boston, MA; §§Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA; and ‖‖Ragon Institute of Massachusetts General Hospital, MIT and Harvard, Charlestown, MA.
J Acquir Immune Defic Syndr. 2013 Aug 15;63(5):602-8. doi: 10.1097/QAI.0b013e31829b662b.
The frequency of hypothalamic-pituitary-adrenal axis dysfunction among HIV-infected patients receiving steroid injections has not been reported, and the risk factors for this adverse event are poorly characterized.
We conducted a retrospective analysis of data from HIV-infected patients in the Partners HealthCare system (Boston, MA) who received corticosteroid injection(s) between 2002 and 2011. Chart review focused on HIV status, antiretroviral therapy [eg, protease inhibitors (PI)], steroid injection(s), and adrenal axis dysfunction (eg, adrenal insufficiency and/or Cushing syndrome). Because all cases occurred among patients on PIs, we performed additional detailed data extraction and conducted univariate and multivariate analyses to identify risk factors in this group.
One hundred seventy-one HIV-infected patients received ≥1 corticosteroid injection(s) in the study period. Nine cases (event frequency: 5.3%; 95% confidence interval: 2.4% to 9.8%) of secondary adrenal insufficiency were diagnosed; 5 (55%) of these 9 patients also had clinical evidence of Cushing syndrome. All cases occurred among the 81 patients on PIs (event frequency among those on PIs: 11.1%; 95% confidence interval: 5.2% to 20.0%). Among patients on PIs, the major risk factor for hypothalamic-pituitary-adrenal axis dysfunction was having ≥2 injections within 6 months.
In this retrospective cohort study, 11% of HIV-infected patients on PIs at the time of steroid injection were later diagnosed with hypothalamic-pituitary-adrenal axis dysfunction. Corticosteroid injections in HIV-infected patients on PIs should only be used with great caution and close monitoring.
接受皮质类固醇注射的 HIV 感染患者的下丘脑-垂体-肾上腺轴功能障碍的频率尚未报道，并且该不良事件的危险因素特征描述较差。
我们对 2002 年至 2011 年间在马萨诸塞州波士顿的 Partners HealthCare 系统接受皮质类固醇注射的 HIV 感染患者进行了回顾性数据分析。图表审查重点关注 HIV 状态、抗逆转录病毒治疗[例如蛋白酶抑制剂（PI）]、皮质类固醇注射和肾上腺轴功能障碍（例如肾上腺功能不全和/或库欣综合征）。由于所有病例均发生在接受 PI 治疗的患者中，因此我们进行了额外的详细数据提取，并进行了单变量和多变量分析，以确定该组的危险因素。
在研究期间，171 名 HIV 感染患者接受了≥1 次皮质类固醇注射。诊断出 9 例（发生率：5.3%；95%置信区间：2.4%至 9.8%）继发性肾上腺功能不全；这 9 例患者中的 5 例（55%）也有库欣综合征的临床证据。所有病例均发生在 81 名接受 PI 治疗的患者中（接受 PI 治疗的患者发生率：11.1%；95%置信区间：5.2%至 20.0%）。在接受 PI 治疗的患者中，发生下丘脑-垂体-肾上腺轴功能障碍的主要危险因素是在 6 个月内接受≥2 次注射。
在这项回顾性队列研究中，接受皮质类固醇注射的 HIV 感染患者中有 11%在接受 PI 治疗时被诊断为下丘脑-垂体-肾上腺轴功能障碍。在接受 PI 治疗的 HIV 感染患者中，应谨慎使用皮质类固醇注射，并密切监测。
