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. 2022 Jul 1;36(8):1061-1071.
doi: 10.1097/QAD.0000000000003176. Epub 2022 Feb 1.

Hypogonadism: a neglected comorbidity in young and middle-aged HIV-positive men on effective combination antiretroviral therapy

Marie Lachâtre  1 , Armelle Pasquet  2   3 , Faïza Ajana  2 , Benoit Soudan  4 , Yann Quertainmont  5 , Georges Lion  6 , Emmanuel Durand  7 , Laurence Bocket  8 , Martine Mole  5 , Pauline Cornavin  2 , Pilartxo Catalan  5 , Éric Senneville  2 , Cécile Goujard  5 , Faroudy Boufassa  9 , Antoine Cheret  5   10
Affiliations

Hypogonadism: a neglected comorbidity in young and middle-aged HIV-positive men on effective combination antiretroviral therapy

Marie Lachâtre et al. AIDS. .

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 6 months. 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 43 years [adjusted odds ratio (aOR) 3.17, 95% confidence interval (95% CI) 1.02-9.86; P = 0.04], total fat percentage more than 19% (aOR3.5, 95% CI 1.18-10.37; P = 0.02), and treatment including efavirenz (aOR3.77, 95% CI 1.29-10.98; P = 0.02). A nadir CD4+ T-cell count more than 200 cells / μl (aOR 0.22, 95% CI 0.07-0.65;P < 0.01) were protective.

Conclusion: Male hypogonadism remains common in young-to-middle-aged PWH with stably suppressed viral replication. Treatment including efavirenz, being over 43 years 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.

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