Hypogonadism -- low serum testosterone -- affected more than one in 10 HIV-positive men in a preliminary single-center study in France. That rate is twice higher than in the general population of similarly aged men. A high percentage of total body fat and more than 5.5 years of antiretroviral therapy (ART) independently predicted hypogonadism.
The study, which was presented at ICAAC 2015, notes that research has linked male hypogonadism to an array of conditions, many of them highly prevalent in men with HIV, including osteoporosis, metabolic syndrome, depression and decreased lean body mass. With the arrival of potent antiretroviral combinations, hypogonadism no longer correlates with low CD4+ count or weight loss, but rather with aging and comorbidities. The researchers conducted this cross-sectional study to determine the prevalence of hypogonadism in a contemporary HIV population of virologically suppressed men and to identify factors associated with hypogonadism.
The study involved 113 men younger than 50 years old with a viral load below 50 copies/mL for more than six months while in care at a single center in Tourcoing, France. Researchers measured free testosterone twice before 9 AM (when testosterone levels are highest). They assessed depression by the Hamilton rating scale, erectile dysfunction by the International Index of Erectile Function-5 score and quality of life by the Aging Male Symptoms scale. Participants had DXA scans to measure bone mineral density and body fat.
Fourteen of 113 men (12.4%) had hypogonadism, with all cases attributed to hypothalamic-pituitary axis dysfunction. Men with hypogonadism were older than eugonadal men (median 45.5 versus 41 years). More than 90% of men with and without hypogonadism were white, and the groups did not differ substantially in body mass index (23.5 and 23 kg/m2), total fat (20% and 19%), proportion of smokers (50% and 41.4%), psychoactive drug users (14.3% and 10.1%), those engaged in physical activity (57.1% and 57.6%) or those who drank more than 20 g of alcohol daily (7.1% and 12.1%).
Median sex hormone-binding globulin measured 61.65 nmol/L in hypogonadal men versus 40.4 nmol/L in eugonadal men (P = .001). Men with hypogonadism also had significantly lower estradiol (13.5 versus 18 pg/mL, P = .001) and prolactin (6 versus 18 pg/mL, P = .01), a higher prevalence of osteoporosis (15.4% versus 9.6%, P = .03), a longer duration of ART (median 9 versus 6 years) and almost a twice-longer duration of antiretroviral therapy.
Logistic regression analysis identified three independent predictors of hypogonadism: (1) total fat mass above 19% (adjusted odds ratio [aOR] 6.41, 95% confidence interval [CI] 1.3 to 32.6, P = .03), (2) more than 5.5 years of antiretroviral therapy (aOR 8.54, 95% CI 1.7 to 42.86, P = .01), and (3) more than two years of integrase inhibitor therapy (aOR 17.03, 95% CI 2.2 to 129.6, P < .01). The researchers caution that the association with integrase inhibitors should be interpreted cautiously because of the wide confidence interval.
The French team concludes that hypogonadism is common in HIV-positive young and middle-aged men. They suggest that thresholds of five years of antiretroviral therapy and 19% total fat could be used to identify men at risk of hypogonadism. The researchers will try to confirm these findings in a larger sample of men.