Hypopituitarism and HIV-infection: a new comorbidity in the HAART era?
Several comorbidities are associated with the HIV infection and may involve also the endocrine-metabolic system. Consistently, the recent development of the therapeutic regimen highly active antiretroviral therapy (HAART) 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. The HIV-related lipodystrophy is associated with alterations in GH dynamics, affecting both basal and stimulated GH secretion. This GHIGF- I secretive pattern resembles that of severe GH deficiency in adulthood due to pituitary diseases, but without leading to IGF-I serum levels below the normal range. The impairment of pituitary GH secretion has been ascribed to the hormonal and metabolic inhibitory effect due to adipose tissue redistribution in HIV-infected males, since in these patients pituitary GH secretion appeared to be inversely related to visceral adipose tissue accumulation and waist to-hip-ratio. However, whether these patients suffer from a true GH deficiency due to an intrinsic pituitary failure or display only a functional reduction of GH secretion due to visceral adiposity remains still a matter of debate, especially in HIV-infected females.
Zirilli
L
L
Chair of Endocrinology, Integrated Department of Medicine, Endocrinology, Metabolism, and Geriatrics, University of Modena and Reggio Emilia, 41100 Modena, Italy.
Orlando
G
G
Diazzi
C
C
Squillace
N
N
Carani
C
C
Guaraldi
G
G
Rochira
V
V
D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D001823:Body Composition / Q000187:drug effects; D015897:Comorbidity; D004700:Endocrine System Diseases / Q000188:drug therapy / Q000209:etiology; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D015497:HIV-1; D039682:HIV-Associated Lipodystrophy Syndrome / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D019382:Human Growth Hormone / Q000627:therapeutic use; D006801:Humans; D007018:Hypopituitarism / Q000188:drug therapy / Q000453:epidemiology*; D008954:Models, Biological
D019382:Human Growth Hormone