Prevalence of testosterone deficiency in HIV-infected men under antiretroviral therapy.

Ana Rita Gomes,Davide Carvalho,Francisco Almeida,António Sarmento,Bernardo Sousa-Pinto,Bernardo Sousa-Pinto,Carolina Germana Silva,Paula Freitas,Pedro Souteiro

doi:10.1186/s12879-016-1892-5

Abstract

BackgroundThe prevalence of hypogonadism in HIV-infected patients is still a matter of debate as there is no standardized consensual diagnostic method. In addition, the etiology and endocrine/metabolic implications of hypogonadism in this population remain controversial. This study aims to determine the prevalence of testosterone deficiency in a single-site hospital and to evaluate its association with potential risk factors, lipodystrophy, metabolic syndrome, and cardiovascular risk.MethodsThis study analyzed 245 HIV-infected men on combined antiretroviral therapy. Patients with low total testosterone (TT) levels (<2.8 ng/mL) and/or low calculated free testosterone (FT) levels (<6.5 ng/dL) were considered testosterone deficient. According to their LH and FSH levels, patients were classified as having hypogonadotropic or hypergonadotropic dysfunction. Other clinical, anthropometric, and analytic parameters were also collected and analyzed.ResultsThe prevalence of testosterone deficiency in our population was 29.4 %. Among them, 56.9 % had hypogonadotropic dysfunction and 43.1 % presented with hypergonadotropic dysfunction. Patients with testosterone deficiency were older (p < 0.001), had higher HbA1c levels (p = 0.016) and higher systolic blood pressure (p = 0.007). Patients with lower testosterone levels had higher prevalence of isolated central fat accumulation (p = 0.015) and had higher median cardiovascular risk at 10 years as measured by the Framingham Risk Score (p = 0.004) and 10-Year ASCVD risk (p = 0.002).ConclusionsThe prevalence of testosterone deficiency in this HIV population is high, with hypogonadotropic dysfunction being responsible for the majority of cases. Testosterone deficiency might predispose to, or be involved, in the pathogenesis of HIV-associated lipodystrophy. Patients with low testosterone levels have higher cardiovascular risk, highlighting the importance of early diagnosis of this condition.

Highlights

The prevalence of hypogonadism in Human immunodeficiency virus (HIV)-infected patients is still a matter of debate as there is no standardized consensual diagnostic method
Anthropometric and analytic variables were analyzed regarding these two categories of testosterone deficiency, patients with elevated gonadotrophins presented a higher frequency of Nucleoside reverse transcriptase inhibitor (NRTI) use (100 % vs. 86.7 %; p = 0.028) and lower CD4+ counts (336.0 vs. 449.0; p = 0.030)
Following the recommendations to use free testosterone (FT) levels in individuals with HIV infection, we used TT and FT calculated by the Vermeulen formula to define testosterone deficiency, in order to avoid false negatives that would possible occur if only TT levels had been used

Summary

Introduction

The prevalence of hypogonadism in HIV-infected patients is still a matter of debate as there is no standardized consensual diagnostic method. The etiology and endocrine/metabolic implications of hypogonadism in this population remain controversial. Like hypogonadism, thyroid dysfunction, adrenal insufficiency, and diabetes were described as more prevalent in HIV patients in the pre-combined antiretroviral therapy (cART) era. They were mainly associated to HIV-related opportunistic infections and advanced multi-organ failure [1,2,3]. The causes of testosterone deficiency among HIV-infected men remain controversial, and there is lack of studies concerning the etiology and metabolic and endocrine consequences of this condition [1]. The prevalence of testosterone deficiency in the HIV population is not well defined, ranging from 16 to 54 %, as slightly different criteria are adopted in different studies [4, 6, 9]

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