Introduction: People living with human immunodeficiency virus (HIV) are at increased risk of developing metabolic disorders, such as obesity, dyslipidemia, insulin resistance, diabetes and hypertension; which may also be associated with hypercortisolism. Due to the similarity between the metabolic changes present in these two clinical situations, several studies have evaluated whether HIV-infected patients have increased levels of cortisol, but the results are not consensual. Urine free cortisol (UFC) is a screening test for hypercortisolism.
Purpose: We aims to determine the relationship between cortisoluria and the presence of metabolic syndrome (MetS) and assess the relationship between the UFC and each components of MetS in HIV-infected patients.
Methods: As part of a cross-sectional study, 219 Caucasian, non-institutionalized, HIV-1 infected adults under cART (combined antiretroviral therapy) were evaluated. For each patient the following data were collected at baseline: demographic data (age, gender), weight, height, waist and hip circumferences and UFC levels. For non-normally distributed continuous variables, we used MannWhitney U tests for comparison between two groups. To evaluate the association of anthropometric parameters with UFC we performed adjusted logistic regression models for the confounding variables (sex, age, duration of disease and cART. We excluded the patients without UFC and with the diagnosis of Cushings syndrome or under corticotherapy. The presence of MetS was defined according to the harmonized International Diabetes Federation criteria of 2009.
Results: Of the 219 patients observed, 61.4% were males, with a mean age of 46.33±11.46 years, BMI of 25.41±5.00 kg/m2, waist circumference of 92.12±12.59 cm and the hip circumference of 95.45±9.66 cm. The median disease duration was 8.11±4.01 years and the cART median duration was 6.67±3.90 years. The median UFC values in patients with SMet were 38.4 μg/day [7127.3] and in those without SMet of 50.1 μg/day [8.9 208.6]. No significant difference in UFC levels in HIV-infected patients with and without MetS (P=0.147), even after adjusting for confounding variables, was observed. The presence of obesity, diabetes, hypertension or dyslipidemia wasnt associated with UFC levels (P=0.509, 0.611, 0.675 and 0.778, respectively).
Conclusion: In our population of HIV-infected patients, MetS was not associated with higher levels of UFC, contrary to previous data in the general population. These findings suggest that the pathophysiological mechanisms of the metabolic syndrome in HIV patients could be different of uninfected population, where the MetS is associated with higher cortisol levels.
18 - 21 May 2019
European Society of Endocrinology