Prevalence of Adrenal Insufficiency in Clinically Stable Adults Living with HIV Attending Outpatient Clinics in Malaysia.

BACKGROUND

Adrenal insufficiency (AI) is a potentially life-threatening condition in people living with HIV/AIDS. Data on this topic are scarce and estimates of its prevalence vary.

OBJECTIVE

To determine the prevalence of AI among people living with HIV and to guide the management strategies.

METHODOLOGY: This is a cross-sectional study conducted at the Infectious Diseases Clinics of two tertiary centres. Clinical and laboratory data were collected, and Synacthen (cosyntropin) stimulation tests were performed. Adrenal antibodies and Adrenocorticotropic Hormone (ACTH) levels were analysed in those who had an inadequate Synacthen response. The data were analysed using SPSS (version 28.0).

RESULTS

A total of 110 stable outpatient adults living with HIV, aged 18 to 80 years, were recruited. The mean age of the studied population was 37.5 ± 10.6 years, 81.8% were male, 23.6% had a normal BMI and 64.5% were either overweight or obese. The median disease duration was 4.5 years and all subjects had been on HAART for a median duration of 3.8 years. Treatment failure occurred in 20% of participants, 41.8% had a history of opportunistic infections and 4.5% had autoimmune diseases. The mean nadir CD4 count was 202 cells/mm3 ± 200 with 60.6% below 200 cells/mm3. At the time of the Synacthen tests, 88.2% had a viral load of <40 copies/ml while 89.1% had a CD4 count >200 cells/mm3. AI was identified in 2 participants (1.8%; 95% CI 0.2-6.4%). Their adrenal antibodies were negative, and ACTH levels were 4.5 ± 5.9 pmol/L. Both had significantly lower nadir CD4 counts (p <0.001), a history of treatment failure (p = 0.039) and symptoms suggestive of AI (p = 0.004).

CONCLUSION

This study revealed a low prevalence of AI (1.8%) among stable HIV patients on HAART. Significant associations with AI were found in participants with lower nadir CD4 counts, a history of treatment failure, and symptoms suggestive of AI.