Nassoro David D, Mkhoi Mkhoi L, Sabi Issa, Meremo Alfred J, Lawala Paul S, Mwakyula Issakwisa Habakkuk
Department of Internal Medicine, Mbeya Zonal Referral Hospital, Mbeya, Tanzania.
Department of Internal Medicine, University of Dar es Salaam, Mbeya College of Health and Allied Sciences, Mbeya, Tanzania.
Int J Endocrinol. 2019 Jun 23;2019:2342857. doi: 10.1155/2019/2342857. eCollection 2019.
Adrenal insufficiency (AI) is one of the most common endocrine disease in patients with HIV/AIDS, leading to high morbidity and mortality in HIV patients who become critically ill. Various etiologies are associated with the condition, including cytomegalovirus (CMV), , lymphoma, Kaposi's sarcoma, and drugs such as rifampin, among others. HIV patients with advanced disease develop relative cortisol deficiency largely due to the reduction of cortisol reserve, which predisposes patients to adrenal crisis in periods of stress or critical illness. The prevalence of AI in HIV/AIDS patients during HAART era is higher in developing than developed countries, probably due to limited access to both diagnosis and adequate treatments which increases the risk of opportunistic infections. The clinical features of functional adrenal insufficiency in HIV/AIDS patients can be masked by various infectious, noninfectious, and iatrogenic causes, which reduce clinical recognition of the condition. Development of simple screening algorithms may help clinicians reach the diagnosis when approaching these patients. In many low-income countries, most HIV patients are diagnosed with advanced disease; thus, further research is necessary to elucidate the prevalence of adrenal insufficiency in HIV/AIDS patients and the condition's impact on mortality in this population.
肾上腺功能不全（AI）是人类免疫缺陷病毒/获得性免疫综合征（HIV/AIDS）患者中最常见的内分泌疾病之一，会导致重症HIV患者出现高发病率和死亡率。多种病因与该病症相关，包括巨细胞病毒（CMV）、淋巴瘤、卡波西肉瘤以及利福平等药物等。晚期HIV患者会出现相对皮质醇缺乏，主要是由于皮质醇储备减少，这使患者在应激或重症期间易发生肾上腺危象。在高效抗逆转录病毒治疗（HAART）时代，HIV/AIDS患者中AI的患病率在发展中国家高于发达国家，这可能是因为诊断和充分治疗的可及性有限，从而增加了机会性感染的风险。HIV/AIDS患者功能性肾上腺功能不全的临床特征可能被各种感染性、非感染性和医源性病因掩盖，这降低了对该病症的临床识别。开发简单的筛查算法可能有助于临床医生在诊治这些患者时做出诊断。在许多低收入国家，大多数HIV患者被诊断为晚期疾病；因此，有必要进一步研究以阐明HIV/AIDS患者中肾上腺功能不全的患病率及其对该人群死亡率的影响。
