HIV and Hepatitis.com Coverage of the 15th
Conference on Retroviruses and Opportunistic Infections (CROI 2008) February
3 - 6, 2008, Boston, MA
The
material posted on HIV and Hepatitis.com about CROI 2008 is not approved by
nor is it a part of CROI 2008.
Antiretroviral
Therapy Is Not a Risk Factor for Hypogonadism in HIV Positive Men
Hypogonadism,
or low testosterone production, is the most common endocrine disorder in HIV
positive men, but little is known about its cause(s).
In a poster
presentation at the 15th Conference on Retroviruses and
Opportunistic Infections last month in Boston, researchers described a prospective
study to determine the prevalence of and risk factors for hypogonadism among male
HIV patients at the TriService AIDS Clinical Consortium, a large HIV clinic in
Rockville, MD.
All HIV positive adult men at the clinic were offered enrollment.
The investigators collected data on patient demographics, CD4 count, HIV viral
load, duration of HIV infection, CDC disease stage, use of anti-HIV medications,
use of hormone supplements, and use of alcohol, tobacco, or recreational drugs.
Questionnaires regarding hypogonadism (Androgen Deficiency in Aging Males
[ADAM]), testicular examination, and measurements of early morning testosterone
levels were performed. Men with hypogonadism, defined as testosterone < 300
ng/dL, underwent an evaluation for its cause and were offered treatment.
Results
•
Of 296 study participants, 50 (17%) had hypogonadism.
•
All of these patients had secondary hypogonadism; 1 had hypothyroidism.
•
The ADAM questionnaire was positive for 93% of the entire cohort.
•
In univariate analyses, predictors of hypogonadism included:
•
increasing age (p = 0.001); •
CDC stage C disease (p = 0.004); •
longer duration of HIV infection (p = 0.002); •
lower CD4 cell nadir (p = 0.03); •
longer duration of antiretroviral therapy (p = 0.002); •
lipodystrophy (p = 0.011).
•
Tobacco use was associated with a lower risk of hypogonadism (p = 0.005).
•
In a multivariate analysis, increasing age (p = 0.002) was associated with hypogonadism
while smoking was protective (p = 0.02).
•
There was no association between hypogonadism and the use of anti-HIV medications.
•
72% of patients with hypogonadism were given testosterone therapy (the rest declined
or had medical conditions precluding its use).
•
Overall, 63% of participants reported satisfaction with testosterone supplementation
and 77% planned to continue replacement therapy.
Conclusion
Based
on these findings, the researchers concluded that hypogonadism is common among
HIV-infected men in the HAART era and "is usually attributable to hypothalamic/pituitary
dysfunction."
They
also noted, "Given its association with increasing age, the prevalence of
hypogonadism may rise as HIV-infected men survive to older ages."
Finally,
they added, "Smoking is protective of hypogonadism, mirroring data in HIV
negative men." They suggested that this may be due to nicotine's effect on
aromatase, an enzyme that processes testosterone in the body.
TriService
AIDS Clinical Consortium, Rockville, MD; Naval Med Ctr, San Diego, CA.
3/18/08
Reference
N Crum-Cianflone, M Bavaro, B Hale, and others (on behalf of the TriService
AIDS Clinical Consortium). Prevalence
and Risk Factors of Hypogonadism among HIV-infected Men. 15th Conference on
Retroviruses and Opportunistic Infections (CROI 2008). Boston, MA. February 3-6,
2008. Abstract 775.
Antiretroviral
Therapy Is Not a Risk Factor for Hypogonadism in HIV Positive Men 
Results
