Abstract
BackgroundHypogonadism is common among HIV-infected men, even among men receiving antiretroviral therapy (ART). Our objective in this study was to determine the prevalence of biochemical hypogonadism among HIV-infected men compared with HIV-uninfected controls. We also examined the use of free testosterone (FT) and total testosterone (TT) measurements in the assessment of biochemical hypogonadism in HIV-infected and –uninfected men.MethodsThis was a cross-sectional analysis from the Multicenter AIDS Cohort Study (MACS). TT levels were measured from archived serum using liquid chromatography-tandem mass spectrometry. FT was calculated from TT and sex hormone-binding globulin (SHBG) (measured by radioimmunoassay) using the Vermeulen equation. Biochemical hypogonadism was defined as having low TT, low FT, or both.ResultsOf 945 men in the MACS Cardiovascular Substudy, T assays were not performed in 89 because of insufficient/no stored serum (n = 18) or use of T replacement therapy (TRT) (n = 71). 530 men had morning (AM) T measurements; 364 (68.7%) were HIV-infected. The prevalence of biochemical hypogonadism was similar in HIV-infected (34/364 = 9.3%) and HIV-uninfected (12/166 = 7.2%) men. Prevalence of hypogonadism, when men on TRT (n = 71) were included in the group of hypogonadal men, was higher in HIV-infected (104/434 = 24.0%) compared with HIV-uninfected (13/167 = 7.8%) men (p < 0.0001). Of 34 HIV-infected men with biochemical hypogonadism not on TRT, 11 (32.4%) had normal TT, but low FT. Of 12 HIV-uninfected men with biochemical hypogonadism not on TRT, none were in this category (p = 0.04) – all had low TT.ConclusionsThe prevalence of biochemical hypogonadism in our sample of HIV-infected men was approximately 10%, with a substantial proportion of these men having a normal TT, but low FT. The measurement of AM FT, rather than TT, in the assessment of hypogonadism in HIV-infected men will likely increase diagnostic sensitivity and should be recommended.
Highlights
Hypogonadism is common among HIV-infected men, even among men receiving antiretroviral therapy (ART), with prevalence estimates ranging from approximately 20% to 70% [1,2,3]
Since elevated sex hormone-binding globulin (SHBG) levels result in higher TT levels, and SHBG is elevated in HIV-infected men [7,8], the guidelines further recommend free testosterone (FT) measurement for men in whom elevated SHBG is suspected [6], including men with HIV
The objectives of our study were to determine the prevalence of hypogonadism among a group of men who participate in the Multicenter AIDS Cohort Study (MACS) and to compare by HIV serostatus biochemical hypogonadism diagnoses made by TT and FT assays
Summary
Hypogonadism is common among HIV-infected men, even among men receiving antiretroviral therapy (ART). We examined the use of free testosterone (FT) and total testosterone (TT) measurements in the assessment of biochemical hypogonadism in HIV-infected and –uninfected men. Hypogonadism is common among HIV-infected men, even among men receiving antiretroviral therapy (ART), with prevalence estimates ranging from approximately 20% to 70% [1,2,3]. Free T measurement in HIV-infected men has been recommended by endocrinologists for over ten years [5,12], there may be low uptake of this recommendation among HIV clinicians, among those who were not practicing early in the HIV epidemic when hypogonadism in HIV disease was initially described [13]
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