Adrenocortical function in Nigerians with human immunodeficiency virus infection.

OBJECTIVE This study sets out to determine the prevalence of adrenocortical insufficiency in persons with HIV infection by determining the response to low-dose (1 µg) ACTH stimulation. DESIGN An experimental study involving people with HIV infection and healthy people. SETTING The study group and the controls were recruited from the Lagos University Teaching Hospital (LUTH). PARTICIPANTS forty-three newly diagnosed and treatment naïve persons with HIV (23 males and 20 females) and 70 (35 males and 35 females) HIV negative subjects completed the study. INTERVENTION One µg Synacthen was given intravenously to stimulate the adrenal glands. MAIN OUTCOME MEASURES Blood was collected for basal cortisol levels and 30 minutes after the injection of ACTH. Cortisol was assayed using ELISA. RESULTS The mean basal cortisol was 154.9 ± 27.2 nmol/L and 239.9 ± 31.6 nmol/L (p<0.001); while the 30-minute post ACTH test cortisol level was 354.8 ± 19.9 nmol/L and 870.9 ± 163.5 nmol/L (p<0.001) and the increment was 100.0 ± 17.2 nmol/L and 588.8 ± 143.4 nmol/L (p<0.001) in HIV and healthy subject group respectively. Using the diagnostic criteria derived for the diagnosis of adrenocortical insufficiency in this study (30 minute cortisol level <380.2 nmol/L and increment from basal to stimulated cortisol level <158.5 nmol/L); fifteen (34.8%) persons with HIV had adrenal insufficiency. CONCLUSION Adrenocortical insufficiency is common in persons with HIV infection, occurring in about 34.8% of patients studied. Clinically evident adrenocortical insufficiency is uncommon in persons with HIV.