Doubled hypogonadism rate in middle-aged men with HIV: fat is a factor
Hypogonadism (low testosterone) affected 12% of middle-aged HIV-positive men, a rate twice that seen in the general population, according to results of a preliminary study in France. More than 5.5 years of antiretroviral therapy (ART) and total fat above 19% independently predicted hypogonadism in these men.
French researchers from Turcoing Hospital and other centres noted that hypogonadism has been linked to an array of conditions in men, including osteoporosis, decreased lean body mass, erectile dysfunction, depression, and metabolic syndrome. The research team observed that hypogonadism prevalence has dropped in men with HIV since the arrival of combination ART and is no longer correlated with low CD4 counts. But because hypogonadism remains poorly defined in men with HIV, they undertook this preliminary single-centre study to define the prevalence of hypogonadism and to identify risk factors.
This cross-sectional study involved 113 young and middle-aged men with virologic suppression on ART. The researchers defined hypogonadism as serum free testosterone (measured twice in the morning, when testosterone is highest) below 70 pg/mL. They used logistic regression to identify factors associated with hypogonadism. They also measured an array of other variables including sociodemographic factors and anthropometric measures and bone density by DXA scan.
The study group had a median age of 41 (interquartile range 36 to 46), 94% were Caucasian, median body mass index measured 23 kg/m2, 42.5% smoked, 11.5% drank more than 20 g of alcohol daily, and 57.5% were physically active. Fourteen men (12.4%) had hypogonadism, all due to hypothalamic-pituitary axis dysfunction. This rate is twice that
of men in the general population, the researchers noted. Men with hypogonadism were older than those with normal testosterone (median 45.3 versus 41 years) and had a higher smoking prevalence (50% versus 41%). They did not differ from eugonadic men in body mass index (23.5 versus 23 kg/m2), trunk fat (18% and 18%) or total fat (20% and 19%).
Men with hypogonadism had a longer duration of HIV infection and antiretroviral therapy, and a higher proportion had taken an integrase inhibitor (21% versus 11%). Osteoporosis was more prevalent among men with hypogonadism (15.4% versus 9.6%, p = 0.03), and they had higher median sex hormone-binding globulin (61.65 versus 40.4 nmol/L, p
= 0.001), lower estradiol (18 versus 13.5 pg/mL, p = 0.001), and lower prolactin (6 versus 18 pg/mL, p = 0.01). Logistic regression identified three variables independently associated with higher odds of hypogonadism, at the following adjusted odds ratios (aOR) and 95% confidence intervals:
- Total fat mass above 19%: aOR 6.41, 1.3 to 32.6, p = 0.03
- More than 5.5 years of ART: aOR 8.54, 1.7 to 42.86, p = 0.01
- More than 2 years of integrase inhibitor therapy: aOR 17.03, 2.2 to 129.6, p < 0.01.
The researchers noted that the association with longer integrase inhibitor therapy must be interpreted cautiously because of the wide confidence interval. They concluded that hypogonadism is common in young and middle-aged men with HIV and should be tracked. They suggested that antiretroviral duration longer than five years and total fat above 19% could be used to identify men at risk. The investigators are recruiting a larger sample to confirm these findings.
Pasquet A, Lachatre M, Soudan B, et al. Preliminary results of the study hypogonadism and persons living with HIV. ICAAC 2015, September 17-21, 2015, San Diego. Abstract H-1207.