Opiate Drug Use: A Potential Contributor to the Endocrine and Metabolic Complications in Human Immunodeficiency Virus Disease

Abstract

Endocrine and metabolic abnormalities are common in human immunodeficiency virus (HIV) disease and have been attributed to both the disease and its treatment. Other risk factors and behaviors may also be important. Approximately 28% of new HIV infections occur in users of injection drugs, such as opiates. We focus on the effects of opiates on multiple endocrine systems and their potential to contribute to the metabolic and endocrine problems in HIV. Opiate use has been associated with hypogonadism, adrenal dysfunction, reduced bone mineral density, and growth-hormone abnormalities. In addition, some studies have suggested abnormalities in glucose and lipid metabolism among opiate users. Although much of the evidence should be viewed as preliminary, these potential abnormalities should be kept in mind when treating opiate-dependent patients infected with HIV.

Neuroendocrine Abnormalities in Drug Abusers and HIV-Infected Individuals: Cortisol Response to Cold Pressor Challenge

“…Although more studies are needed, our data support the concept that changes in the neuroendocrine system may be one of the major complications of HIV infection among drug abusers [4] .…”

“…A number of endocrine and metabolic abnormalities have been described among individuals infected with HIV-1 and these abnormalities may contribute to increased morbidity and mortality [1][2][3][4] . It has been proposed that HIV-1 infection may directly or in association with other factors bring about adverse effects on the neuroendocrine systems [5,6] and in particular, on the hypothalamic pituitary adrenal (HPA) axis.…”

“…All of these substances are likely to result in endocrine dysfunctions even in the absence of HIV infection. Cooper et al, [4] reported that the adverse effects of opiates on cortisol levels may be related to opportunistic infections associated with drug abuse and in heroin abuse, and adrenal insufficiency may be a result of the effects of heroin on the neurotransmitters that regulate the secretion of corticotrophin-releasing hormones (CRH) [20] . Cocaine abuse has also been related to abnormalities in HPA axis activity [21] .…”

Disfunção do eixo gonadotrófico em homens com infecção pelo HIV/Aids

“…O hipogonadismo secundário é mais prevalente, sendo caracterizado por baixos níveis de testosterona livre e/ou biodisponível e concentrações de gonadotrofinas normais ou reduzidas e associado à presença de doenças sistêmicas oportunistas, caquexia, ação de citocinas, como TNF-α, uso de drogas, como o acetato de megestrol, glicocorticoides, opioides e drogas de abuso (3)(4)(5)27). Todos esses fatores estão associados à disfunção hipotalâmica-hipofisária, com consequente redução da liberação de LH e hormônio folículo-estimulante (FSH).…”

Gonadal and Adrenal Abnormalities in Drug Users: Cause or Consequence of Drug Use Behavior and Poor Health Outcomes

“…Direct viral effects or effects for antiretroviral medications result in a high prevalence of hypogonadism, altered concentrations of sex hormone binding globulins, altered circadian production of steroids, adrenal dysfunction and metabolic abnormalities in HIV infected men and women [38] . For this reason, the relationship between endocrine and metabolic abnormalities in drug users may be confounded by HIV infection and treatment.…”