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J Acquir Immune Defic Syndr. 2013 Aug 15;63(5):602-8. doi: 10.1097/QAI.0b013e31829b662b.

High frequency of hypothalamic-pituitary-adrenal axis dysfunction after local corticosteroid injection in HIV-infected patients on protease inhibitor therapy.

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  • 1*Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA; †Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA; ‡Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA; §Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA; ‖Department of Pharmacy, Massachusetts General Hospital, Boston, MA; ¶Research Design Center/Biostatistics Research Center, Clinical and Translational Science Institute, Tufts University, Boston, MA; #Division of Endocrinology, Yale University School of Medicine, New Haven, CT; **Division of Endocrinology, Massachusetts General Hospital, Boston, MA; ††Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA; ‡‡Harvard University Center for AIDS Research, Boston, MA; §§Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA; and ‖‖Ragon Institute of Massachusetts General Hospital, MIT and Harvard, Charlestown, MA.

Abstract

BACKGROUND:

The frequency of hypothalamic-pituitary-adrenal axis dysfunction among HIV-infected patients receiving steroid injections has not been reported, and the risk factors for this adverse event are poorly characterized.

METHODS:

We conducted a retrospective analysis of data from HIV-infected patients in the Partners HealthCare system (Boston, MA) who received corticosteroid injection(s) between 2002 and 2011. Chart review focused on HIV status, antiretroviral therapy [eg, protease inhibitors (PI)], steroid injection(s), and adrenal axis dysfunction (eg, adrenal insufficiency and/or Cushing syndrome). Because all cases occurred among patients on PIs, we performed additional detailed data extraction and conducted univariate and multivariate analyses to identify risk factors in this group.

RESULTS:

One hundred seventy-one HIV-infected patients received ≥1 corticosteroid injection(s) in the study period. Nine cases (event frequency: 5.3%; 95% confidence interval: 2.4% to 9.8%) of secondary adrenal insufficiency were diagnosed; 5 (55%) of these 9 patients also had clinical evidence of Cushing syndrome. All cases occurred among the 81 patients on PIs (event frequency among those on PIs: 11.1%; 95% confidence interval: 5.2% to 20.0%). Among patients on PIs, the major risk factor for hypothalamic-pituitary-adrenal axis dysfunction was having ≥2 injections within 6 months.

CONCLUSIONS:

In this retrospective cohort study, 11% of HIV-infected patients on PIs at the time of steroid injection were later diagnosed with hypothalamic-pituitary-adrenal axis dysfunction. Corticosteroid injections in HIV-infected patients on PIs should only be used with great caution and close monitoring.

PMID:
23714741
[PubMed - indexed for MEDLINE]
PMCID:
PMC3805773
Free PMC Article
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