Health status is related to testosterone, estrone and body fat: moving to functional hypogonadism in adult men with HIV. Issue 1 (January 2021) - De Vincentis, Sara
Abstract : Objective: Hypogonadism is common in HIV-infected men. The relationship between health status, sex steroids and body composition is poorly known in HIV. The aim was to investigate the association between health status (comorbidities/frailty), body composition, and gonadal function in young-to-middle-aged HIV-infected men. Design: Prospective, cross-sectional, observational study. Methods: HIV-infected men aged < 50 years and ongoing Highly Active Antiretroviral Therapy were enrolled. Serum total testosterone (TT), estradiol (E2), estrone (E1) were measured by liquid chromatography-tandem mass spectrometry, LH and FSH by immunoassay. Free testosterone (cFT) was calculated by Vermeulen equation. Body composition was assessed by dual-energy X-ray absorptiometry and abdominal CT scan. Multimorbidity (MM) and frailty were defined as ≥3 comorbidities and by a 37-item index, respectively. Results: A total of 316 HIV-infected men aged 45.3 ± 5.3 years were enrolled. Body fat parameters were inversely related to cFT and TT, and directly related to E1 and E2/testosterone (TS) ratio. Patients with MM had lower cFT ( P < 0.0001) and TT ( P = 0.036), and higher E1 ( P < 0.0001) and E2/TS ratio ( P = 0.002). Frailty was inversely related to cFT (R 2 = 0.057, P < 0.0001) and TT (R 2 = 0.013, P = 0.043), and directly related to E1 (R 2 = 0.171, P < 0.0001), E2 (R 2 = 0.041, P = 0.004) and E2/TS ratio (R 2 = 0.104, P < 0.0001). Conclusions: Lower TT and cFT, higher E1, E2/TS ratio and visceral fat were independently associated to poor health status and frailty, being possible hallmarks of unhealthy conditions in adult HIV-infected men. Overall, MM, frailty and body fat mass are strictly associated to each other and to sex steroids, concurring together to functional male hypogonadism in HIV.