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


METHODS
This 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.


RESULTS
The 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).


CONCLUSIONS
The 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.
Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal. mimed10099@med.up.pt.
Ana Rita
AR
Gomes
Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar São João, Porto, Portugal.
Pedro
P
Souteiro
Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
Carolina Germana
CG
Silva
Department of Health Information and Decision Sciences, Faculty of Medicine (CIDES), University of Porto, Rua Dr. Placido da Costa, 4200-450, Porto, Portugal.|Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Rua Dr. Placido da Costa, 4200-450, Porto, Portugal.
Bernardo
B
Sousa-Pinto
Infectious Diseases Department, Centro Hospitalar São João, Faculty of Medicine, University of Porto, Porto, Portugal.
Francisco
F
Almeida
Infectious Diseases Department, Centro Hospitalar São João, Faculty of Medicine, University of Porto, Porto, Portugal.
António
A
Sarmento
Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar São João, Porto, Portugal.|Faculty of Medicine, i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.
Davide
D
Carvalho
Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar São João, Porto, Portugal.|Faculty of Medicine, i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.
Paula
P
Freitas
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology; D005640:Follicle Stimulating Hormone / Q000097:blood; D006442:Glycated Hemoglobin / Q000378:metabolism; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D039682:HIV-Associated Lipodystrophy Syndrome; D006801:Humans; D007006:Hypogonadism / Q000097:blood / Q000453:epidemiology*; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000453:epidemiology; D008875:Middle Aged; D011174:Portugal / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D013739:Testosterone / Q000097:blood*
D044966:Anti-Retroviral Agents; D005640:Follicle Stimulating Hormone; D006442:Glycated Hemoglobin; D007986:Luteinizing Hormone; D013739:Testosterone; C517652:hemoglobin A1c protein, human
Cardiovascular risk; HIV infection; Hypogonadism; Lipodystrophy