&NA;HIV infection is associated with a number of endocrine and metabolic manifestations involving the adrenal, gonadal, thyroid, and growth hormone (GH)‐insulin‐like growth factor‐I axes. Endocrine dysfunction may result rarely from end‐organ and/or pituitary/hypothalamic tissue destruction from opportunistic infections, direct effects of the HIV virus, and/or indirect effects of associated cytokines on hormonal metabolism. New medications used in the treatment of HIV disease, such as Megace®, may also have profound effects on endocrine function. Adrenal insufficiency and/or impaired adrenal reserve are increasingly recognized in this population, suggesting the need for screening in the appropriate clinical context. In addition, hormonal adaptation to stress, severe illness, and protein calorie malnutrition in patients with AIDS may also effect endocrine function, resulting in decreased androgen levels and acquired GH resistance. Moreover, the loss of potent endogenous anabolic hormones such as testosterone and GH may in turn contribute independently to the severe and disproportionate loss of lean body mass characteristic of the wasting syndrome. In this article, the endocrine manifestations of AIDS with a particular emphasis on neuroendocrine mechanisms will be reviewed, followed in each case by a discussion of clinical implications.