Living with HIV - Lower Testosterone at Middle Age

[Jim Allen]

  For some reason, I genuinely thought it was already well known and had even noted down that lower testosterone remained an issue despite viral suppression & ART... The possible efavirenz link is news to me though.

Poz.com in full: https://www.poz.com/article/low-testosterone-middle-age-may-persist-despite-hiv-treatment

In Brief:

A study of middle-aged men living with HIV found rates of hypogonadism (low testosterone) more commonly seen in older men, and effective HIV treatment didn’t change that, according to a paper published in the journal AIDS.

Between 2013 and 2016, Marie Lachâtre, MD, of the Cocin-Pasteur Center for Clinical Investigation in Paris, and colleagues recruited 240 men living with HIV who had been on effective antiretroviral treatment for six months or more and had an undetectable viral load (defined here as fewer than 50 copies).

Regardless of hormone levels, 55% of participants reported erectile dysfunction or a drop in quality of life, and one third reported symptoms of depression.

When the researchers looked at what factors were associated with lower testosterone levels, they found that men who had used efavirenz were nearly four times more likely to experience low testosterone. Men who were older and those who had a body fat percentage of 19% or more were also more likely to have low testosterone. But having a higher nadir CD4 count was associated with a 78% reduction in the odds of low testosterone.

While lower nadir CD4 counts and HIV itself have long been associated with hypogonadism among men living with HIV, the mechanism by which efavirenz is associated isn’t clear, wrote Lachâtre and colleagues.

“The correlation between age and [male hypogonadism] is well established, but our findings (based on a reliable [free testosterone] assay) show for the first time that this correlation is independent of viral control and of total body fat percentage,” the team wrote.