Adrenal insufficiency in HIV/AIDS: a review

Mifsud, Simon; Gauci, Zachary; Gruppetta, Mark; Mallia Azzopardi, Charles; Fava, Stephen

doi:10.1080/17446651.2021.1979393

Cited by 19Adrenal Hormones and DisordersHIV-related health complications and treatmentsStress Responses and Cortisol

Adrenal insufficiency in HIV/AIDS: a review

Mifsud, Simon, Gauci, Zachary, Gruppetta, Mark, Mallia Azzopardi, Charles, Fava, Stephen·2021·Expert Review of Endocrinology & Metabolism

DOI 10.1080/17446651.2021.1979393

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Abstract

INTRODUCTION: Adrenal insufficiency (AI) is one of the most common potentially life-threatening endocrine complications in people living with human immunodeficiency virus (PLHIV) infection and acquired immunodeficiency syndrome (AIDS). AREAS COVERED: In this review, the authors explore the definitions of relative AI, primary AI, secondary AI and peripheral glucocorticoid resistance in PLHIV. It also focuses on the pathophysiology, etiology, diagnosis and management of this endocrinopathy in PLHIV. A literature review was conducted through Medline and Google Scholar search on the subject. EXPERT OPINION: Physicians need to be aware of the endocrinological implications of HIV infection and its treatment, especially CYP3A4 enzyme inhibitors. A high index of clinical suspicion is needed in the detection of AI, especially in PLHIV, as it may present insidiously with nonspecific signs and symptoms and may be potentially life threatening if left untreated. Patients with overt primary and secondary AI require glucocorticoid replacement therapy. Overt primary AI also necessitates mineralocorticoid replacement. On the other hand, the management of relative AI remains controversial. In order to reduce the risk of adrenal crisis during periods of stress, the short-term use of glucocorticoids may be necessary in relative AI.

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Antiretrovirals can cause adrenal insufficiency through impaired cortisol metabolism by cytochrome P4503A4 isozyme disruption.
“antiretrovirals (through impaired cortisol metabolism by cytochrome P4503A4 isozyme disruption) (44, 45)”
From The Changing Face of Drug-induced Adrenal Insufficiency in the Food and Drug Administration Adverse Event Reporting System (2022) · cites this paper as [45]

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Inflammatory and Infectious Disorders in Endocrine Pathology
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Adrenal Insufficiency
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Endocrine Disorders and Metabolic Complications in HIV
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Association of antiretroviral therapy regimens with serum cortisol abnormalities in people living with HIV/AIDS: a retrospective study
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Prevalence of Adrenal Insufficiency in Clinically Stable Adults Living With HIV Attending Outpatient Clinics in Malaysia
Goh, Q., Rajoo, S., Mustafa, N., & Tong, C. V. (2026) · Journal of the ASEAN Federation of Endocrine Societies · doi:10.15605/jafes.041.02.6383

Adrenal Insufficiency in HIV Infection: A Review and Recommendations
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Adrenal Insufficiency: A Forgotten Diagnosis in HIV/AIDS Patients in Developing Countries
Nassoro, D. D., Mkhoi, M. L., Sabi, I., Meremo, A., Lawala, P., & Mwakyula, I. H. (2019) · International Journal of Endocrinology · doi:10.1155/2019/2342857 · Cited by 34 · see citing works
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A Case of Primary Adrenal Insufficiency in a Patient with Acquired Immunodeficiency Syndrome
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Clinical features of adrenal insufficiency in patients with acquired immunodeficiency syndrome
Piédrola, G., Casado, J. L., Lopez, E., Moreno, A. M., Pérez-Elı́as, M. J., & García‐Robles, R. (1996) · Clinical Endocrinology · doi:10.1111/j.1365-2265.1996.tb02066.x · Cited by 61 · see citing works

Authors: Mifsud, S., Gauci, Z., Gruppetta, M., Mallia Azzopardi, C., & Fava, S.
Affiliations: Mater Dei Hospital (MT)
Department of Infectious Diseases and General Medicine, Mater Dei Hospital, Msida, Malta
Corresponding author: Mifsud, Simon
ORCID: Gruppetta, Mark
Fava, Stephen
Venue: Expert Review of Endocrinology & Metabolism
Publisher: Informa UK Limited
Published: 2021-09-14
Volume: 16
Issue: 6
Pages: 351-362
ISSN: 1744-6651 (ISSN-L)
1744-8417
DOI: 10.1080/17446651.2021.1979393
OpenAlex: W3200277417
Cited by: 19
References: 149
Citations by year: 2026: 3 · 2025: 5 · 2024: 6 · 2023: 4 · 2022: 1
FWCI: 0.42
Type: journal article
Language: en
Open access: closed
Locations: Expert Review of Endocrinology & Metabolism (publishedVersion)
PubMed (publishedVersion)
Funders: no funding
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Health Sciences › Medicine › Emergency Medicine › HIV-related health complications and treatments
Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
Keywords: adrenal insufficiency, HIV/AIDS, Addison's disease, secondary adrenal insufficiency, relative adrenal insufficiency, glucocorticoid resistance, glucocorticoid replacement therapy, mineralocorticoid replacement, adrenal crisis, CYP3A4 inhibitors, endocrine disorders, pathophysiology, diagnosis
MeSH terms: Acquired Immunodeficiency Syndrome, Adrenal Insufficiency, Glucocorticoids, Humans, HIV Infections, Hormone Replacement Therapy

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Adrenal insufficiency in HIV/AIDS: a review

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