Diagnosis and Treatment of Androgen Deficiency in Human Immunodeficiency Virus–Infected Men and Women

Abstract

Androgen deficiency is a common endocrine abnormality among men and women with human immunodeficiency virus (HIV) infection. Low testosterone concentrations are associated with lower CD4 cell count, advanced stage of illness, medication use, and weight loss. Signs and symptoms may be nonspecific. The most useful laboratory indicator is the serum bioavailable (free) testosterone concentration. A number of different testosterone preparations for treatment of androgen deficiency in HIV-infected men now exist. Administration of im testosterone significantly increases weight and lean body mass, energy, quality of life, and depression scores in HIV-infected men with low testosterone levels. Newer transdermal and gel preparations provide more-consistent steady-state dosing but are not as well tested, and sufficient testosterone concentrations may not be achieved with their use. Androgen deficiency is also common among HIV-infected women. Preliminary studies suggest that use of physiological testosterone administration, to achieve testosterone levels within the normal range, is of benefit in HIV-infected women, but further studies are necessary to define the therapeutic role of androgen therapy in this population.

Neurodegeneration and Ageing in the HAART Era

“…Furthermore, there are risk factors for AD that are common in HAART-treated patients, including insulin resistance, raised cholesterol especially in mid-life, and testosterone deficiency, which occurs in approximately 30% of patients with advanced HIV disease (Brew 2004;Mylonakis et al 2001;Okun et al 2004). Additionally, apoE4 is a risk factor for HAND in some studies especially those who are older (Pemberton et al 2008;Valcour et al 2008).…”

Erectile Dysfunction and Hypogonadism among Men with HIV

“…Patients were classified as having ED if they had a positive IIEF score (Ͻ21) 23 or answered affirmatively to the presence of ED or the inability to obtain or maintain an erection. Hypogonadism was defined as a morning testosterone level of less than 300 ng/dL.…”

“…The cause of hypogonadism in HIV-infected cases are poorly defined, but may include malnutrition, increased cytokine levels, opportunistic infections, HIV infection itself, and medications. 17,20,23 Determining the risk factors for both ED and hypogonadism among HIV-infected men is important, because both conditions have been linked to a reduced quality of life and other clinical sequelae. 24, 25 We performed a study to establish the prevalence and risk factors for both ED and hypogonadism among HIV-infected men at a large HIV clinic.…”

Psychopharmacologic treatment of patients with HIV/AIDS

“…These include clinical and subclinical hypothyroidism [15,16], hypogonadism [17], and adrenal insuffi ciency [18], as well as Graves' disease (autoimmune thyroiditis) [16]. Multiple etiologic mechanisms have been hypothesized, including viral and opportunistic infections and neoplastic infi ltration of endocrine glands, antiretroviral therapy, and autoimmune phenomena (eg, immune reconstitution infl ammatory syndrome).…”