Endocrine Abnormalities in HIV Infection

Treated and untreated human immunodeficiency virus (HIV) infection is associated with perturbations in body composition and in the function of the endocrine axes. In advanced stages of disease, individuals with untreated HIV may have wasting, decreased lean mass, and abnormalities of multiple endocrine axes, including growth hormone (GH) resistance, androgen deficiency, oligo- or amenorrhea in women, and impaired adrenal function. By contrast, individuals with well-treated HIV often experience weight gain and ectopic fat accumulation. Whereas frank endocrine abnormalities are less common in people with well-treated HIV, cardiometabolic abnormalities such as insulin resistance, dyslipidaemia, and non-alcoholic fatty liver disease are relatively common. Finally, bone mineral density may be reduced, and cardiovascular risk is increased in individuals with HIV, in large part due to the immune dysregulation and persistent inflammation that accompanies even treated HIV. Appropriate care for individuals with HIV includes evaluation of any potential signs or symptoms of endocrine dysregulation as well as assessment and management of cardiovascular risk factors.