ECE2019 Poster Presentations Reproductive Endocrinology 1 (40 abstracts)
Gonadal Function in Human Immunodeficiency Virus (HIV)-Infected Men: comparison between Isotopic Dilution-Liquid Chromatography-Tandem Mass Spectrometry (ID-LC-MS/MS) and Chemiluminescent Immunoassay (CI)
Sara De Vincentis 1, , Maria Chiara Decaroli 1, , Flaminia Fanelli 3 , Marco Mezzullo 3 , Chiara Diazzi 2 , Fabio Morini 1 , Davide Bertani 1 , Daniele Santi 1, , Enrica Baraldi 4 , Simonetta Tagliavini 4 , Laura Roli 4 , Tommaso Trenti 4 , Uberto Pagotto 3 , Giovanni Guaraldi 5 & Vincenzo Rochira 1,
1Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; 2Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy; 3Endocrinology Unit and Center for Applied Biomedical Research (CRBA), Department of Medical and Surgical Sciences, University of Bologna – S. Orsola-Malpighi Hospital, Bologna, Italy; 4Department of Laboratory Medicine and Anatomy Pathology, Azienda USL of Modena, Modena, Italy; 5Multidisciplinary Metabolic Clinic, Unit of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy.
Background: HIV-infection is associated to premature decline of serum T. However, prevalence and biochemical characterization of hypogonadism in HIV-infected men are still to be well defined.
Aim: To evaluate the gonadal status in HIV-infected men by assessing circulating total T (TT) with either ID-LC-MS/MS or CI.
Methods: Prospective, cross-sectional, observational study on HIV-infected men with ongoing Highly Active Antiretroviral Therapy (HAART). Serum TT, gonadotropins and sex hormone-binding globulin (SHBG) were measured by CI (Architect, Abbott, USA). TT was also assessed by a validated in house ID-LC-MS/MS. Free T (FT) was calculated by Vermeulen equation. Hypogonadism was defined as serum TT levels below 320 ng/dl and/or free T levels below 64 pg/ml. Statistical analysis: Parameters were not normally distributed and Mann-Whitney U test, was used to compare continuous variables. Categorical variables were compared using Chi-Square test, while correlations were performed using linear regression models.
Results: 315 consecutive HIV-infected men were enrolled (mean age 45.56±5.61 years; average duration of HIV-infection 16.57±10.45 years). Serum TT levels assessed by LC-MS/MS (mean 652.1+229.1 ng/dl) were significantly lower compared to CI (mean 740.2+274.7 ng/dl) (P<0.0001). As a consequence, prevalence of T deficiency was significantly higher comparing LC-MS-MS to CI (5.4% vs 3.2%, P<0.0001). 56 patients (17.8%) showed SHBG above the normal range (>71.4 nmol/l). Considering calculated FT, the prevalence of hypogonadism was 9.8% using LC-MS/MS and 7.0% using CI, with a significant difference between methodologies (P<0.0001). TT assessed with LC-MS-MS was directly related to TT assessed with CI (Beta=0.956, R2=0.913, P<0.0001), as well as FT (Beta=0.934, R2=0.873, P<0.0001). TT combined with luteinizing hormone (LH) levels was used to classify hypogonadism. By including compensated form of hypogonadism, the prevalence raised to 15.6% for TT and to 17% for FT.
Conclusions: To the best of our knowledge, this is the first properly-designed prospective study aiming to investigate the gonadal status of HIV-infected men with both LC-MS/MS and CI, together with gonadotropins. Notwithstanding the strong correlation found between the two methodologies, the prevalence of hypogonadism results underestimated when CI is used compared to ID-LC-MS/MS in HIV-infected patients. In clinical practice, SHBG for calculated FT is essential for the detection of T deficiency, revealing the real prevalence of hypogonadism in this clinical setting.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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