Division of Endocrinology and Metabolism, Department of Medicine, UConn Health, 263 Farmington Avenue, Farmington, CT, 06030-5456, USA.
Department of Medicine, UConn Health, Farmington, CT, 06030, USA.
J Endocrinol Invest. 2018 Aug;41(8):881-899. doi: 10.1007/s40618-017-0812-x. Epub 2018 Jan 8.
Patients with human immunodeficiency virus (HIV) are living longer with effective antiretroviral therapies and are enjoying near normal life span. Therefore, they are encountering endocrine issues faced by the general population along with those specific to HIV infection. The purpose of this article is to review the common endocrine aspects of HIV infection, and the early detection and management strategies for these complications.
Recent literature on HIV and endocrine disease was reviewed.
HIV can influence endocrine glands at several levels. Endocrine glandular function may be altered by the direct effect of HIV viral proteins, through generation of systemic and local cytokines and the inflammatory response and via glandular involvement with opportunistic infections and HIV-related malignancies. Endocrine disorders seen in people with HIV include metabolic issues related to obesity such as diabetes, hyperlipidemia, lipohypertrophy, lipoatrophy and lipodystrophy and contribute significantly to quality of life, morbidity and mortality. In addition, hypogonadism, osteopenia and osteoporosis are also more prevalent in the patients with HIV. Although disorders of hypothalamic-pituitary-adrenal axis resulting in adrenal insufficiency can be life threatening, these along with thyroid dysfunction are being seen less commonly in the antiretroviral therapy (ART) era. ARTs have greatly improved life expectancy in people living with HIV but can also have adverse endocrine effects.
Clinicians need to have a high index of suspicion for endocrine abnormalities in people with HIV as they can be potentially life threatening if untreated. Endocrine evaluation should be pursued as in the general population, with focus on prevention, early detection and treatment to improve quality of life and longevity.
由于有效的抗逆转录病毒疗法，人类免疫缺陷病毒（HIV）感染者的寿命得以延长，并且生活质量接近正常。因此，他们除了面临 HIV 感染特有的问题外，还会遇到普通人群中存在的内分泌问题。本文旨在回顾 HIV 感染常见的内分泌方面的问题，以及这些并发症的早期检测和管理策略。
对 HIV 与内分泌疾病相关的近期文献进行了回顾。
HIV 可在多个层面影响内分泌腺体。HIV 病毒蛋白的直接作用、全身和局部细胞因子的产生以及炎症反应、机会性感染和 HIV 相关恶性肿瘤导致的腺体受累，均可改变内分泌腺的功能。HIV 感染者中出现的内分泌紊乱包括与肥胖相关的代谢问题，如糖尿病、血脂异常、脂肪肥厚、脂肪萎缩和脂肪营养不良，这些问题严重影响生活质量、发病率和死亡率。此外，HIV 感染者中还更常见性腺功能减退、骨质疏松症和骨量减少。虽然下丘脑-垂体-肾上腺轴的紊乱导致肾上腺功能不全可能危及生命，但在抗逆转录病毒治疗（ART）时代，这些情况以及甲状腺功能障碍已不那么常见。ART 大大提高了 HIV 感染者的预期寿命，但也会对内分泌产生不良影响。
由于未治疗的内分泌异常可能危及生命，因此临床医生应高度怀疑 HIV 感染者存在内分泌异常。应像在普通人群中一样，对内分泌异常进行评估，重点是预防、早期发现和治疗，以提高生活质量和延长寿命。
