Arver S, Sinha-Hikim I, Beall G, Guerrero M, Shen R, Bhasin S
Division of Endocrinology, Metabolism, and Molecular Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California 90059, USA.
J Androl. 1999 Sep-Oct;20(5):611-8.
Weight loss is an important determinant of disease outcome in human immunodeficiency virus (HIV)-infected men. Others have suggested that a defect in dihydrotestosterone (DHT) generation contributes to weight loss in HIV-infected men. To determine whether DHT levels correlate with weight loss independently of changes in testosterone levels, we prospectively measured serum total- and free-testosterone and DHT levels in 148 consecutive HIV-infected men and 42 healthy men. Thirty-one percent of HIV-infected men had serum testosterone levels less than 275 ng/dL, the lower limit of the normal male range; of these, 81% had normal or low LH and FSH levels (hypogonadotropic), and 19% had elevated LH and FSH levels (hypergonadotropic). Overall, serum testosterone, free-testosterone, and DHT levels were lower in HIV-infected men than in healthy men, but serum DHT-to-testosterone ratios were not significantly different between the two groups. Serum total- and free-testosterone levels were lower in HIV-infected men who had lost 5 lb or more of weight in the preceding 12 months than in those who had not lost any weight. Serum DHT levels and DHT-to-testosterone ratios did not differ between those who had lost weight and those who had not. Serum testosterone and free-testosterone levels, but not DHT levels, correlated with weight change and with Karnofsky performance status. We also performed a retrospective analysis of data from a previous study in which HIV-infected men with serum testosterone levels less than 400 ng/dL had been treated with placebo or testosterone patches designed to nominally release 5 mg testosterone over 24 hours. Serum testosterone-to-DHT ratios did not change after testosterone treatment. Changes in fat-free mass were correlated with changes in both serum testosterone (r = 0.42, P = 0.018) and DHT (r = 0.35, P = 0.049) levels. Serum total- testosterone and DHT levels were highly correlated with one another, and when the change in serum testosterone was taken into account, serum DHT levels no longer showed a significant correlation with change in fat-free mass. We conclude that DHT levels are lower in HIV-infected men than in healthy men but that neither DHT levels nor DHT-to-testosterone ratios correlate with weight loss. During testosterone treatment, serum DHT levels increase proportionately, but the increments in serum testosterone correlate with the change in fat-free mass. Our data do not support the hypothesis that a defect in DHT generation contributes to weight loss in HIV-infected men independently of changes in testosterone levels; it is possible that such a defect might exist in HIV-infected men with more severe weight loss.
体重减轻是人类免疫缺陷病毒（HIV）感染男性疾病预后的重要决定因素。其他人曾提出，二氢睾酮（DHT）生成缺陷导致HIV感染男性体重减轻。为了确定DHT水平是否独立于睾酮水平变化与体重减轻相关，我们前瞻性地测量了148例连续的HIV感染男性和42例健康男性的血清总睾酮、游离睾酮和DHT水平。31%的HIV感染男性血清睾酮水平低于275 ng/dL，即正常男性范围的下限；其中，81%的人促黄体生成素（LH）和促卵泡生成素（FSH）水平正常或偏低（低促性腺激素性），19%的人LH和FSH水平升高（高促性腺激素性）。总体而言，HIV感染男性的血清睾酮、游离睾酮和DHT水平低于健康男性，但两组之间血清DHT与睾酮的比值无显著差异。在过去12个月内体重减轻5磅或更多的HIV感染男性，其血清总睾酮和游离睾酮水平低于未减重的男性。减重者与未减重者的血清DHT水平及DHT与睾酮的比值无差异。血清睾酮和游离睾酮水平与体重变化及卡诺夫斯基功能状态相关，但DHT水平与体重变化无关。我们还对一项先前研究的数据进行了回顾性分析，在该研究中，血清睾酮水平低于400 ng/dL的HIV感染男性接受了安慰剂或设计为在24小时内名义释放5 mg睾酮的睾酮贴片治疗。睾酮治疗后血清睾酮与DHT的比值未发生变化。去脂体重的变化与血清睾酮（r = 0.42，P = 0.018）和DHT（r = 0.35，P = 0.049）水平的变化均相关。血清总睾酮和DHT水平彼此高度相关，当考虑血清睾酮的变化时，血清DHT水平与去脂体重的变化不再显示显著相关性。我们得出结论，HIV感染男性的DHT水平低于健康男性，但DHT水平及DHT与睾酮的比值均与体重减轻无关。在睾酮治疗期间，血清DHT水平成比例增加，但血清睾酮的增加与去脂体重的变化相关。我们的数据不支持DHT生成缺陷独立于睾酮水平变化导致HIV感染男性体重减轻的假设；在体重减轻更严重的HIV感染男性中可能存在这样的缺陷。
