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

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.

Endocrinopathies in Hiv Infected Patients

“…Although there was no correlation between age and testosterone, there was a trend towards declining testosterone level with age. Consistent with other studies, the presented data show that the prevalence of testosterone deficiency increases with age (although not statistically significant), as it happens in the general population [10]. Testosterone production by testicular Leydig cells is closely regulated by the hypothalamicpituitary-gonadal (HPG) axis via production of luteinizing hormone (LH).…”

Lipodystrophy diagnosis in people living with HIV/AIDS: prediction and validation of sex-specific anthropometric models

“…The prevalence of lipodystrophy among people living with HIV/AIDS can range from 41 to 70% [ 29 , 30 ]. This imprecise prevalence is partially due to the absence of a methodological consensus for diagnosing lipodystrophy.…”

Serum Reproductive hormone levels in male symptomatic HIV/AIDS patients on Antiretroviral therapy negative to Malaria parasite in Nnewi, Anambra State, Nigeria

“…This is in line with previous studies. [29][30][31][32] Hypogonadism is a clinical condition characterized by low serum testosterone levels occurring in association with any of the signs and symptoms including sexual dysfunction, weight and muscle mass loss, fatique, depressed mood and anemia. 33,34 This decrease may be as a result of the effect of HIV on the gonads, 35 or due to cytokine effect; as HIV infection is known to upregulate tumour necrosis factor and interleukin-1 36 , resulting in decreased testicular steroidogenesis.…”