ECE2009 Poster Presentations Steroid Receptors (10 abstracts)
Calculated free testosterone as ‘gold standard’ for diagnosis of hypogonadism among HIV-infected men
Oscar Moreno-Perez 1 , Corina Escoin 2 , Carmen Serna-Candel 4 , Nieves Arias 1 , Victor Gonzalez 1 , Rocio Alfayate 3 , Sergio Reus 2 , Montserrat Mauri 3 , Joaquin Portilla 2 & Antonio Pico 1
1Department Endocrinology, Hospital General Universitario Alicante, Alicante, Spain; 2Unit of Intectious Diseases, Hospital General Universitario Alicante, Alicante, Spain; 3Hormones Laboratory, Hospital General Universitario Alicante, Alicante, Spain; 4Department Neurology, Hospital Clinico San Carlos, Madrid, Spain.
Background: HIV-associated hypogonadism is a prevalent endocrine disorder, total testosterone (TT) test is not useful for its diagnosis, Endocrine Society clinical practice guidelines have recently proposed calculated free testosterone (FT) as screening test of hypogonadism in HIV infected men, but no clinical study has been published using this approach in HIV population to date. Our aim was to study prevalence and risk factors for hypogonadism in HIV-infected men using FT.
Methods: About 90 caucasic HIV-infected men -without HCV infection or diabetes- were studied. Patients were classified by antiretroviral treatment: naïve, protease inhibitors (PI)-containing HAART and non-nucleoside (NN)-containing HAART (never exposed to PI). All patients completed standardized questionnaires regarding hypogonadal symptoms (AMS, ADAM). Early morning TT, SHBG and albumin tests were performed to calculate FT. Hypogonadism was defined as FT<6.5 ng/dl. Logistic regression analyses were performed to asses risk factors associated to hypogonadism.
Results: Mean age was 42 years (25–68). Participants had been HIV-positive for a mean of 7.8±5.6 years, median CD4+ count: 465 cells/mm3 (IQR, 365–676). About 84% were receiving HAART and 31.5% reported lipodystrophy. Hypogonadism was observed in 13.3%; belonging 50% to PI group and 50% to NN group. In univariate analyses, hypogonadism was associated with increasing age (odds ratio (OR) 1.13 for a 1-year increment, CI 1.04–1.2) and longer duration of HIV-infection (OR 1.12 for a 1-year increment, CI 1.007–1.3). In multivariate analysis, the association persists. AMS and ADAM questionnaires had a specificity of 37.7 and 37.7% respectively to diagnose hypogonadism in HIV patients.
Conclusions: Prevalence of hypogonadism is remarkable in HIV patients and is associated to older age and duration of HIV infection. Diagnosis of hypogonadism must include FT in any HIV-infected men, because of clinical implication and absence of specific predictive disease factors or useful screening scales in this population.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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