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Meta-Analysis
. 2021 Aug 12;10(8):2067.
doi: 10.3390/cells10082067.

The Prevalence of Hypogonadism and the Effectiveness of Androgen Administration on Body Composition in HIV-Infected Men: A Meta-Analysis

Daniele Santi  1   2 , Giorgia Spaggiari  2 , Walter Vena  3 , Alessandro Pizzocaro  3 , Mario Maggi  4 , Vincenzo Rochira  1   2 , Giovanni Corona  5
Affiliations
Meta-Analysis

The Prevalence of Hypogonadism and the Effectiveness of Androgen Administration on Body Composition in HIV-Infected Men: A Meta-Analysis

Daniele Santi et al. Cells. .

Abstract

Background: Hypogonadism is a common comorbidity in human immunodeficiency virus (HIV)-infected men, although the real prevalence is difficult to be estimated. Moreover, in HIV settings, the efficacy of exogenous testosterone (Te) administration at improving body composition remains unclear.

Aim of the study: This review has a double aim. First, to estimate the prevalence of pituitary-testis axis abnormality in HIV-infected patients compared to uninfected subjects. Second, to evaluate the effect of androgen administration on body composition in HIV-infected men.

Materials and methods: A systematic review of the literature and meta-analysis was carried out. Two separated literature searches were performed, the first to evaluate the prevalence of Te deficiency in HIV-infected men and the second one to evaluate effects of androgen administration on body composition.

Results: The overall prevalence of Te deficiency in HIV-infected men was calculated from 41 studies, showing a 26% prevalence, which was even higher when free T (fT) levels, more than total T, were considered. Indeed, TT serum levels were similar between HIV patients and controls, although higher SHBG and lower fT were detected in HIV populations. When HIV-infected men were treated with exogenous Te, a significant increase in body weight, lean body mass and fat free mass was detected.

Conclusion: The systematic review confirms the high prevalence of Te deficiency in HIV-infected men, particularly when fT has been considered. Moreover, chronic androgen supplementation improves body composition, affecting the lean mass compartment. However, considering the general frailty of HIV patients, a tailored indication for Te therapy should be advocated.

Keywords: HIV; androgen replacement treatment; body composition; hypogonadism; testosterone.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
Forest plot showing hypogonadism prevalence in studies detected in the first literature search. fT: free testosterone; LL: lower limit; UL: upper limit; TT: total testosterone.
Figure 3
Figure 3
Forest plot comparing HIV-infected patients and controls detected in the first literature search for total testosterone serum levels (panel A), sex hormone binding globulin (SHBG) (panel B), free testosterone (Panel C), follicle stimulating hormone (FSH) (panel D), and luteinising hormone (LH) (panel E).
Figure 3
Figure 3
Forest plot comparing HIV-infected patients and controls detected in the first literature search for total testosterone serum levels (panel A), sex hormone binding globulin (SHBG) (panel B), free testosterone (Panel C), follicle stimulating hormone (FSH) (panel D), and luteinising hormone (LH) (panel E).
Figure 4
Figure 4
Forest plot reporting groups detected in the second literature search for changes in sex hormone binding globulin (SHBG) between study and control groups (Panel A). Panel B reports the sensitivity analysis for hypogonadism, and Panel C shows the sensitivity analysis for wasting syndrome.
Figure 4
Figure 4
Forest plot reporting groups detected in the second literature search for changes in sex hormone binding globulin (SHBG) between study and control groups (Panel A). Panel B reports the sensitivity analysis for hypogonadism, and Panel C shows the sensitivity analysis for wasting syndrome.
Figure 5
Figure 5
Forest plot comparing study and control groups detected in the second literature search, considering body weight change (WC) (kg) (Panel A), lean body mass (LBM) (Panel B), and fat free mass (FFM) change (Panel C).
Figure 5
Figure 5
Forest plot comparing study and control groups detected in the second literature search, considering body weight change (WC) (kg) (Panel A), lean body mass (LBM) (Panel B), and fat free mass (FFM) change (Panel C).
Figure 6
Figure 6
Forest plot reporting drop out occurrence between study and control groups detected in the second literature search.
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