Laudat A, Blum L, Guechot J, Picard O, Cabane J, Imbert JC, Giboudeau J. Changes in systemic gonadal and adrenal steroids in asymptomatic human immunodeficiency virus-infected men: relationship with the CD4 cell counts. Eur J Endocrinol 1995;133:418–24. ISSN 0804–4643
Serum sex hormone-binding globulin (SHBG), testosterone, non-SHBG-bound testosterone, androstenedione, dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and cortisol were measured in 58 homosexual men seropositive for human immunodeficiency virus (HIV), all clinically asymptomatic (Centers for Disease Control 1993 classification stage A). The HIV patients were divided into four groups according to the CD4 lymphocyte count—group 1 (more than 500/μl, N= 14), group 2 (between 350 and 500/μl, N= 16), group 3 (between 200 and 349/μl, N = 22) and group 4 (less than 200/μl, N = 6)—and compared with 11 antibody-negative men as controls. The SHBG levels were significantly increased in groups 1, 2, 3 (p < 0.01) and 4 (p < 0.05) compared with controls, with no differences between groups of patients. Compared with controls, testosterone concentrations were significantly lower in group 4 (p < 0.05) and non-SHBG-bound testosterone levels were significantly lower in groups l(p < 0.05), 2 (p < 0.01), 3 (p < 0.001) and group 4 (p < 0.001); DHT and androstenedione levels were significantly lower in group 4 (p < 0.05) and DHEA levels were significantly lower in group 2, group 3 (p < 0.01) and group 4 (p< 0.05) than in controls. Cortisol levels were significantly increased in groups 1 and 4 (p < 0.05) and FSH and LH concentrations were not significantly higher in HIV-infected men than in controls. Also, the DHEA, androstenedione, non-SHBG-bound testosterone and DHT levels were correlated with CD4 cell counts, showing that hypogonadism occurs as the CD4 lymphocytes decrease. A strong reverse correlation between CD4 cell counts and cortisol/DHEA ratios (p < 0.001) confirms the alterations in adrenal steroid secretion, with a shift from androgen to glucocorticoid production as the disease progresses. These data show that in asymptomatic HIV-infected patients serum SHBG levels increase independently of CD4 cells counts, even in patients with undiminished CD4 cell counts; an alteration in serum androgen occurs as the CD4 cell counts decrease; and the cortisol/DHEA ratios increase as the CD4 cell counts decrease, resulting from alterations in adrenal secretion with both a decrease in serum DHEA levels correlated with CD4 cell counts and a slight increase in cortisol levels.
Jérôme Guéchot, Laboratoire de Biochimie-Hormonologie, Hôpital Saint-Antoine, 184 rue du Faubourg, Saint-Antoine, 75571 Paris Cedex 12, France