Key considerations for people living with HIV

Hypogonadism is a common endocrine abnormality in PLWHIV and can be described as either primary (defect of the gonad) or secondary/hypogonadotropic (disorder external to the gonad) hypogonadism. Although both have been linked to HIV infection, secondary hypogonadism is more common among PLWHIV.1,2,3



Compared with age-matched, non-HIV-infected control subjects, unbound testosterone levels are often significantly lower in PLWHIV.4 The prevalence of low testosterone levels in HIV-infected men with AIDS-related complex or AIDS has been estimated to be as high as 50%, with significantly lower serum testosterone levels observed in those with more advanced disease.1 By contrast, in HIV-infected men receiving HAART, hypogonadism has been shown to be present in approximately 20% of patients.5



Hypogonadism can affect both men and women, but androgen deficiency is better characterised in men. During the course of progressive HIV disease, weight loss is reported to precede the fall in total serum testosterone levels in men.6 Similarly, androgen deficiency has been shown to be common in women with AIDS wasting.7 In cases where HIV- associated weight loss is evident, the measurement of testosterone levels is recommended.8 However, guidelines from the Endocrine Society recommend against making a diagnosis of ‘androgen deficiency’ in women because of the lack of a well-defined clinical syndrome and normative data on total or free testosterone levels that can be used to define the disorder.9





References

  1. Dobs AS, Dempsey MA, Ladenson PW, et al. Endocrine disorders in men infected with human immunodeficiency virus. Am J Med. 1988;84:611–616.
  2. Mylonakis E, Koutkia P, Grinspoon S. Diagnosis and treatment of androgen deficiency in human immunodeficiency virus-infected men and women. Clin Infect Dis. 2001;33:857–864.
  3. Grinspoon S, Bilezikian JP. HIV disease and the endocrine system. NEJM. 1992;327:1360–1365.
  4. Laudat A, Blum L, Guéchot J, et al. Changes in systemic gonadal and adrenal steroids in asymptomatic human immunodeficiency virus-infected men: relationship with the CD4 cell counts. Eur J Endocrinol. 1995;133:418–424.
  5. Rietschel P, Corcoran C, Stanley T, et al. Prevalence of hypogonadism among men with weight loss related to human immunodeficiency virus infection who were receiving highly active antiretroviral therapy. Clin Infect Dis. 2000;31:1240–1244.
  6. Coodley, Loveless MO, Nelson HD, et al. Endocrine function in the HIV wasting syndrome. J Acquir Immune Defic Syndr. 1994;7:46–51.
  7. Grinspoon S, Corcoran C, Miller K, et al. Body composition and endocrine function in women with acquired immunodeficiency syndrome wasting. J Clin Endocrinol Metab. 1997;82:1332–1337.
  8. Endocrine Society. Clinical Guidelines on Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes. 2010. Accessed 22 February 2011.
  9. Endocrine Society. Androgen Therapy in Women. 2006. Accessed 2 September 2011.