Endocrine Abstracts

Background: Hypogonadism and sexual dysfunction, particularly erectile dysfunction (ED), are common in men living with HIV (MLWH), but the link between testosterone levels and sexual function remains unclear in this population. The aim of this study was to estimate the prevalence of hypogonadism and sexual dysfunction and to explore the relationship between HIV-related variables and gonadal and sexual function in MLWH.

Materials and Methods: Serum total testosterone (TT), sex hormone binding globulin (SHBG), luteinizing hormone (LH), follicle-stimulating hormone (FSH) and estradiol (E2) were assessed in sixty MLWH. Free testosterone was calculated (cFT) by using the Vermeulen equation. Sexual function was assessed through the International Index of Erectile Function-15 (IIEF-15). According to guidelines, diagnosis of biochemical hypogonadism was made when serum TT ≤ 12 nmol/l and/or cFT < 0.22 nmol/l. Body mass index (BMI), waist circumference (WC) and HIV-related variables (duration of HIV infection, CD4⁺ cells count, and antiretroviral therapy used, ART, such as Integrase Strand Transfer Inhibitor, INSTI, Non-Nucleoside Reverse Transcriptase Inhibitor, NNRTI, Nucleoside Reverse Transcriptase Inhibitor, NRTI and Protease Inhibitor, PI), were also evaluated.

Results: Out of 60 MLWH, 42 (70%) presented ED. Subgroup analysis was performed according to the presence or absence of hypogonadism, that was observed in 11 MLWH (18.3%), 8 of whom (72.7%) presented hypogonadotropic hypogonadism. Interestingly, no differences in the five domains of IIEF-15 were found between MLWH with hypogonadism and those with eugonadism, despite pathological scores in both groups. In addition, MLWH with hypogonadism compared to those with eugonadism had significantly increased BMI (P=0.046) and smoking habits prevalence (P=0.002) and lower E2 (P=0.017). Considering gonadal function in the whole cohort, TT was negatively related to BMI (r=-0.595, P=0.001) and WC (r=-0.656, P=0.011), and positively related to E2 (r=0.457, P=0.006) and SHBG (r=0.325, P=0.033). cFT was related to BMI (r=-0.519 P=0.023) and WC (r=-0.719, P=0.019). Considering ART, higher TT, SHBG and E2 were found in MLWH using PI (respectively, P=0.018, P=0.015 and P=0.020). Moreover, prevalence of ED was higher in MLWH using INSTI (P=0.017).

Conclusion: Sexual dysfunction is a highly prevalent multifactorial disorder in MLWH. Decreased serum testosterone levels, which are also related to increased visceral fat accumulation, are not the only driver of the onset of ED. HIV-related factors, such as ART, also appear to have an impact on gonadal and sexual function. Consequently, the clinical management of sexual health in MLWH requires a multidisciplinary approach, involving experts in infectious diseases and sexual medicine.