Several co-morbidities are associated with the HIV infection involving also the endocrine-metabolic system. Consistently, the recent development of HAART therapy ruled out a significant improvement both in the prognosis and life expectancy of HIV-infected patients, but disclosed also new serious drug-related toxicity. Of these, the lipodystrophy syndrome is the most frequent, occurring in up to 83% of HIV-infected patients under HAART. HIV-related lipodystrophy is associated with metabolic alterations consisting with severe dyslipidemia, insulin resistance, hyperinsulinism, impaired glucose metabolism, and diabetes mellitus. Among endocrine diseases, clinically relevant bone loss and male testosterone deficiency are very frequent. Depletion of bone mineral density accounts for both osteopenia and osteoporosis that are surprisingly observed more often in men with HIV infection. The finding of low circulating testosterone is observed in about 20% of HIV-infected men under HAART and seems to be more frequently associated with inappropriate low serum LH, suggesting a dysfunction of the hypothalamic-pituitary unit. As alterations in GH dynamics are also common in HIV-infected patients, it is possible to hypothesize that the hypothalamuspituitary unit is affected in the setting of HIV, but if a true pituitary disorder or only a functional reduction of pituitary secretive pattern are involved in these hormonal alterations remains to be determined. The pituitary impairment has been mainly ascribed to the hormonal and metabolic inhibitory effect due to adipose tissue redistribution in these patients, but the impact of both HIV per se and medications on pituitary function has not studied in detail. The prevalence of thyroid diseases is similar to that observed in the general population. Owing to the complexity and the coexistence of more than one metabolic and hormonal abnormalities in a single HIV patient, in clinical practice, a multidisciplinary approach involving also the endocrinologist represents the best choice for managing HIV patients.
30 Apr - 04 May 2011
European Society of Endocrinology