The determination of total testosterone and free testosterone (RIA) are not applicable to the evaluation of gonadal function in HIV-infected males.
BACKGROUND
Hypogonadism is common in human immunodeficiency virus (HIV)-infected men; the high concentration of sex hormone binding globulin (SHBG) in this population, induces a "false increase" in total testosterone (TT) values.


OBJECTIVE
To validate the determination of TT and measured free testosterone (FT [radioimmunoassay {RIA}]) for hypogonadism diagnosis in an HIV-infected population using calculated free testosterone (CFT) as reference method; and also to determine the prevalence and identify the risks factors of hypogonadism.


METHODS
Cross-sectional, observational study. Ninety HIV-infected males (42 ± 8.2 years), not HCV coinfected, antiretroviral therapy (ART)-naive (14 patients), on current ART with enhanced protease inhibitor (PI) (39 patients), or patients on PI-naive ART (NN) (37 patients).


METHODS
CFT was calculated by determining TT, SHBG, and albumin (Vermeulen's formula); hypogonadism was defined as CFT <0.22 nmol/L (reference range for young healthy males in our laboratory); sensitivity of TT and FT (RIA) for hypogonadism diagnosis was calculated.


RESULTS
Twelve patients (13.3%, 95% confidence interval [CI] 7.8-21.9) by CFT presented hypogonadism. TT and FT (RIA) presented a sensitivity of less than 30% in the diagnosis of hypogonadism. Logistic regression multivariate analysis confirmed an independent association between hypogonadism, the patient's age per decade, odds ratio (OR) 6.9 (CI 1.9-24.8; P = 0.003), and longer duration of HIV infection per decade, OR 13.1 (CI 1.3-130.6; P = 0.02). Hypogonadism was associated with erectile dysfunction.


CONCLUSIONS
TT and FT (RIA) are not useful in the differential diagnosis of hypogonadism in HIV-infected males. There is a significant prevalence of hypogonadism in HIV-infected males, with the patient's age and duration of the disease being the only identifiable risk factors.
Moreno-Pérez
Oscar
O
Endocrinology and Nutrition Department, Hospital General Universitario de Alicante, Alicante, Spain. moreno_osc@gva.es
Escoín
Corina
C
Serna-Candel
Carmen
C
Portilla
Joaquín
J
Boix
Vicente
V
Alfayate
Rocio
R
González-Sánchez
Victor
V
Mauri
Montserrat
M
Sánchez-Payá
José
J
Picó
Antonio
A
D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D003430:Cross-Sectional Studies; D005640:Follicle Stimulating Hormone / Q000097:blood; D015658:HIV Infections / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007006:Hypogonadism / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011388:Prolactin / Q000097:blood; D011863:Radioimmunoassay; D012016:Reference Values; D012307:Risk Factors; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism; D013739:Testosterone / Q000097:blood*
D019380:Anti-HIV Agents; D012738:Sex Hormone-Binding Globulin; D013739:Testosterone; D011388:Prolactin; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone