title: The determination of total testosterone and free testosterone (RIA) are not applicable to the evaluation of gonadal function in HIV-infected males.
abstract: 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.
authors.affiliation: Endocrinology and Nutrition Department, Hospital General Universitario de Alicante, Alicante, Spain. moreno_osc@gva.es
authors.forename: Oscar
authors.initials: O
authors.lastname: Moreno-Pérez
authors.forename: Corina
authors.initials: C
authors.lastname: Escoín
authors.forename: Carmen
authors.initials: C
authors.lastname: Serna-Candel
authors.forename: Joaquín
authors.initials: J
authors.lastname: Portilla
authors.forename: Vicente
authors.initials: V
authors.lastname: Boix
authors.forename: Rocio
authors.initials: R
authors.lastname: Alfayate
authors.forename: Victor
authors.initials: V
authors.lastname: González-Sánchez
authors.forename: Montserrat
authors.initials: M
authors.lastname: Mauri
authors.forename: José
authors.initials: J
authors.lastname: Sánchez-Payá
authors.forename: Antonio
authors.initials: A
authors.lastname: Picó
mesh_terms: 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*
chemical_list: D019380:Anti-HIV Agents; D012738:Sex Hormone-Binding Globulin; D013739:Testosterone; D011388:Prolactin; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone