Prevalence of Adrenocortical Insufficiency in Treatment-Naïve HIV Patients in Maiduguri: A Cross-Sectional Study

Abstract

Background: Human immunodeficiency virus (HIV) infection is often associated with various endocrine disorders, including adrenal dysfunction, particularly adrenocortical insufficiency (AI), which represents a significant yet frequently overlooked complication in HIV-infected individuals, particularly within resource-constrained healthcare environments. The condition remains substantially underdiagnosed despite its potential for severe clinical consequences. While highly active antiretroviral therapy (HAART) is known to improve immune function and reduce comorbidities, its effect on adrenal function, particularly in treatment-naïve HIV-infected patients, requires further investigation. Objective: This study aimed to determine the prevalence of adrenocortical insufficiency (AI) in treatment-naïve HIV-infected patients in Maiduguri. Methods: This cross-sectional study involved newly diagnosed, treatment-naïve HIV patients and apparently healthy individuals. Adults aged ≥18 years were enrolled, with 138 stable HIV patients and 132 healthy subjects completing the study. Data were collected using a standardized sheet. Serum cortisol levels were measured at 0, 30, and 60 minutes after a 1µg ACTH (adrenocorticotrophic hormone) stimulation test. Normal cut-off reference values for serum cortisol were derived from the healthy subjects. AI was defined as a peak serum cortisol level of < 504 nmol/L at 30 or 60 minutes after 1µg ACTH stimulation and an increment of < 124 nmol/L. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 23.0, with statistical significance set at P < 0.05. Results: A total of 270 participants completed the study, and data from 220 subjects (129 HIV-positive, 91 healthy subjects) were analyzed. Among HIV patients, 58 (42.0%) were males and 80 (58.0%) were females. The mean age of HIV patients was 36.07±8.87 years, significantly higher than healthy subjects (31.19±11.18 years, p = 0.001). The median basal (0 min) cortisol level