ABSTRACT
OBJECTIVE: Male hypogonadism is poorly characterized in young-to-middle-aged people with HIV (PWH). We used a reliable free testosterone assay to assess the prevalence and predictive factors for male hypogonadism in PWH on effective combined antiretroviral therapy (cART). DESIGN: A French cross-sectional study from January 2013 to June 2016. METHODS: We included HIV-1-infected men aged between 18 and 50years with HIV loads of 50 RNA copies/ml or less, on effective cART for at least 6âmonths. Hypogonadism was defined, according to guidelines, as a mean calculated serum free testosterone concentration less than 70pg/ml (Vermeulen equation). Sociodemographic, anthropo-metric, bone-densitometry, hormonal, immunovirological, metabolic, and therapeutic parameters were collected. The IIEF-5, HAM-D, and AMS scales, respectively, assessed erectile function, depression, and quality of life. RESULTS: Overall, 240 patients were enrolled, 231 were analyzed. Low free testosterone concentrations (<70pg/ml) were recorded in 20 patients (8.7%), and were exclusively of secondary origin. In multivariable analysis, the risk factors predictive of male hypogonadism were age more than 43âyears [adjusted odds ratio (aOR) 3.17, 95% confidence interval (95% CI) 1.02-9.86; P â=â0.04], total fat percentage more than 19% (aOR3.5, 95% CI 1.18-10.37; P â=â0.02), and treatment including efavirenz (aOR3.77, 95% CI 1.29-10.98; P â=â0.02). A nadir CD4+ T-cell count more than 200âcells / µl (aOR 0.22, 95% CI 0.07-0.65;Pâ<â0.01) were protective. CONCLUSION: Male hypogonadism remains common in young-to-middle-aged PWH with stably suppressed viral replication. Treatment including efavirenz, being over 43âyears old, and having a total body fat percentage greater than 19% could be used as criteria for identifying PWH at risk. Early screening for male hypogonadism might improve care by identifying patients requiring testosterone replacement.
Subject(s)
HIV Infections , Hypogonadism , Adolescent , Adult , Antiretroviral Therapy, Highly Active , Child, Preschool , Comorbidity , Cross-Sectional Studies , HIV Infections/complications , HIV Infections/drug therapy , HIV Infections/epidemiology , Humans , Hypogonadism/epidemiology , Infant , Male , Middle Aged , Quality of Life , Testosterone/adverse effects , Young AdultABSTRACT
Male hypogonadism is poorly defined in people living with HIV. Using a reliable free-testosterone assay, we examined the prevalence and risk factors of male hypogonadism among people living with HIV on effective antiretroviral therapy. Male hypogonadism was found in 12.4% of patients, twice the rate reported in the general population of the same age. Two risk thresholds, namely 5 years of antiretroviral therapy and 19% total body fat, may help to identify patients at risk.