Sellmeyer D E, Grunfeld C
Department of Medicine, University of California, San Francisco, USA.
Endocr Rev. 1996 Oct;17(5):518-32. doi: 10.1210/edrv-17-5-518.
Numerous alterations in endocrine function are observed in HIV infection. Direct destruction of endocrine organs by HIV itself or by invasive infection with opportunistic organisms resulting in loss of function is rare. When acutely ill, HIV patients can develop the metabolic derangements that accompany any severe systemic disorder. Studies of thyroid function tests emphasize that the presence of acute secondary infection must be analyzed when evaluating such patients. In addition to euthyroid sick syndrome other hormonal axes are affected by severe illness. These alterations may be cytokine mediated. As with seronegative patients, these changes can be transient and resolve with successful treatment of the intervening illness. Given the complexity of HIV disease, future reports should characterize patients by CD4 cell count, history of AIDS-indicating illnesses, and viral load. Viral burden is an independent predictor of immunosuppression and progression to AIDS. A large number of medications used in the treatment of HIV infection and related illnesses can alter endocrine function, mineral and electrolyte balance, and substrate turnover. Drug therapy must be considered in the evaluation of endocrine abnormalities in HIV-infected patients and carefully characterized in studies of these patients. The endocrine effects of medications used in the treatment of HIV infection are summarized in Table 3. Concomitant factors that affect endocrine function independent of the HIV virus can confound results in these patients. For example, opiate use affects PRL, gonadotropins, and cortisol response to ACTH stimulation. Investigations in HIV-infected patients must include careful descriptions of the study population and comparison to relevant controls. HIV-infected patients may also demonstrate more subtle alterations in endocrinological function in early, relatively asymptomatic, stages. The etiology and clinical significance of these changes, particularly their relationship to cytokines, continues to be investigated. The sequential studies of stable aldosterone levels despite decreased aldosterone response to ACTH stimulation indicate that alterations in response to provocative testing do not predict the development of hormonal insufficiency in this patient population. Similar longitudinal studies need to be done for the other hormonal axes to further delineate the endocrinological alterations in HIV infection. Finally, when the rationale for hormone replacement is debatable, double-blind, placebo-controlled studies are necessary. Transient improvement in clinical status during open-label treatment does not prove hormone insufficiency. The long-term efficacy and safety of hormonal therapy must be demonstrated.
在HIV感染中可观察到内分泌功能的众多改变。HIV本身或机会性生物体的侵袭性感染直接破坏内分泌器官导致功能丧失的情况很少见。急性病时，HIV患者会出现伴随任何严重全身性疾病的代谢紊乱。甲状腺功能测试研究强调，评估此类患者时必须分析急性继发感染的存在情况。除了正常甲状腺病态综合征外，其他激素轴也会受到严重疾病的影响。这些改变可能由细胞因子介导。与血清阴性患者一样，这些变化可能是暂时的，并会随着中间疾病的成功治疗而消退。鉴于HIV疾病的复杂性，未来的报告应以CD4细胞计数、艾滋病指征性疾病史和病毒载量来描述患者。病毒载量是免疫抑制和进展为艾滋病的独立预测指标。用于治疗HIV感染及相关疾病的大量药物可改变内分泌功能、矿物质和电解质平衡以及底物周转。在评估HIV感染患者的内分泌异常时必须考虑药物治疗，并在对这些患者的研究中仔细描述其特征。用于治疗HIV感染的药物的内分泌作用总结于表3中。独立于HIV病毒影响内分泌功能的伴随因素可能会混淆这些患者的结果。例如，使用阿片类药物会影响催乳素、促性腺激素以及皮质醇对促肾上腺皮质激素刺激的反应。对HIV感染患者的研究必须包括对研究人群的仔细描述，并与相关对照进行比较。HIV感染患者在早期相对无症状阶段也可能表现出更细微的内分泌功能改变。这些变化的病因和临床意义，特别是它们与细胞因子的关系，仍在研究中。尽管醛固酮对促肾上腺皮质激素刺激的反应降低，但醛固酮水平稳定的系列研究表明，激发试验反应的改变并不能预测该患者群体中激素不足的发生。需要对其他激素轴进行类似的纵向研究，以进一步描绘HIV感染中的内分泌改变。最后，当激素替代的基本原理存在争议时，双盲、安慰剂对照研究是必要的。开放标签治疗期间临床状态的短暂改善并不能证明激素不足。必须证明激素治疗的长期疗效和安全性。
