Abstract
Background: Hypogonadism is a common comorbidity in human immunodeficiency virus (HIV)-infected men, although the real prevalence is difficult to be estimated. Moreover, in HIV settings, the efficacy of exogenous testosterone (Te) administration at improving body composition remains unclear. Aim of the study: This review has a double aim. First, to estimate the prevalence of pituitary–testis axis abnormality in HIV-infected patients compared to uninfected subjects. Second, to evaluate the effect of androgen administration on body composition in HIV-infected men. Materials and Methods: A systematic review of the literature and meta-analysis was carried out. Two separated literature searches were performed, the first to evaluate the prevalence of Te deficiency in HIV-infected men and the second one to evaluate effects of androgen administration on body composition. Results: The overall prevalence of Te deficiency in HIV-infected men was calculated from 41 studies, showing a 26% prevalence, which was even higher when free T (fT) levels, more than total T, were considered. Indeed, TT serum levels were similar between HIV patients and controls, although higher SHBG and lower fT were detected in HIV populations. When HIV-infected men were treated with exogenous Te, a significant increase in body weight, lean body mass and fat free mass was detected. Conclusion: The systematic review confirms the high prevalence of Te deficiency in HIV-infected men, particularly when fT has been considered. Moreover, chronic androgen supplementation improves body composition, affecting the lean mass compartment. However, considering the general frailty of HIV patients, a tailored indication for Te therapy should be advocated.
Highlights
The residual 23 studies were excluded after the full-text evaluation for unavailability of Te serum levels or because they were abstracts presented during congresses (Figure 1)
Present data show that the prevalence of hypogonadism in human immunodeficiency virus (HIV) subjects is similar to that reported in other subjects with chronic diseases [44], such as those with diabetes mellitus [45], metabolic syndrome (MetS) [46], or erectile dysfunction [47], or who are using drugs that potentially interfere with T production [48,49]
This metaanalysis confirms the results of a few studies showing that hypogonadism occurs earlier in HIV-infected men [4] when compared HIV-uninfected men since age was not associated with the occurrence of hypogonadism, as is generally expected in the general population [50]
Summary
An impairment of the hypothalamic–pituitary–gonadal axis is frequently reported in HIV populations, there is a highly variable incidence, depending on both the criteria used to diagnose hypogonadism and the clinical characteristics of patients enrolled [3]. Despite this heterogeneous picture, the well-known age-related decline in testosterone (Te) serum levels seems anticipated in HIV patients [4,5]. Available studies assessing the prevalence of hypogonadism in HIV-infected patients reported very variable percentages, leaving open the question of the real interconnection between hypogonadism and HIV [3]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
