Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
HIV Med. 2018 Oct;19(9):634-644. doi: 10.1111/hiv.12644. Epub 2018 Jul 10.
The aim of the study was to characterize contemporary patterns and correlates of testosterone therapy (TTh) use and discontinuation by HIV serostatus among men in the Multicenter AIDS Cohort Study (MACS).
Self-reported testosterone use data were collected semiannually from 2400 (1286 HIV-infected and 1114 HIV-uninfected) men who have sex with men. Multivariable Poisson regression was used to estimate prevalence ratios for TTh use and predictors of TTh discontinuation (2012-2015).
Use was higher among HIV-infected compared with HIV-uninfected men in all age strata, with an age-adjusted prevalence of 17% vs. 5%, respectively (adjusted prevalence ratio 3.7; P < 0.001). Correlates of use in the multivariable model were similar by HIV serostatus: white race, the Los Angeles (LA) site, more than one recent sexual partner, non-smoking status, and higher American Heart Association/American College of Cardiology (AHA/ACC) cardiovascular disease (CVD) risk score category (approximately 70% of testosterone users were in the high-risk category). Compared with HIV-uninfected men, HIV-infected men more frequently reported building muscle mass as a motivation for testosterone use. The TTh discontinuation rate was 20.9/100 person-years [95% confidence interval (CI) 17.3, 25.0/100 person-years]. Relative to HIV-uninfected men, HIV-infected men were half as likely to discontinue (adjusted incidence rate ratio 0.4; P < 0.001). Discontinuation was 40% higher in the period after the US Food and Drug Administration (FDA) safety communication for testosterone in 2014, independent of co-factors (P = 0.06).
Given the high prevalence of both TTh use and CVD risk among HIV-infected men, the benefits and risks of TTh should be examined in future studies of aging HIV-infected men and monitored routinely in clinical practice.
本研究旨在描述男男性行为者中，艾滋病毒感染者与非感染者使用及停止使用睾丸激素治疗（testosterone therapy，TTh）的模式和相关因素。
对 2400 名男男性行为者（1286 名艾滋病毒感染者和 1114 名艾滋病毒非感染者）进行了半年度的自我报告睾丸激素使用数据收集。采用多变量泊松回归估计 TTh 使用的患病率比和 TTh 停药的预测因素（2012-2015 年）。
在所有年龄组中，艾滋病毒感染者使用 TTh 的比例均高于艾滋病毒非感染者，分别为调整后患病率的 17%和 5%（调整后患病率比 3.7；P < 0.001）。多变量模型中使用的相关性在艾滋病毒血清学状态上相似：白种人、洛杉矶（LA）地点、有多于一个最近性伴侣、不吸烟和更高的美国心脏协会/美国心脏病学会（AHA/ACC）心血管疾病（CVD）风险评分类别（大约 70%的睾丸激素使用者处于高危类别）。与艾滋病毒非感染者相比，艾滋病毒感染者更常报告增加肌肉质量是使用睾丸激素的动机。TTh 的停药率为 20.9/100 人年[95%置信区间（CI）为 17.3，25.0/100 人年]。与艾滋病毒非感染者相比，艾滋病毒感染者停药的可能性减半（调整后的发病率比为 0.4；P < 0.001）。2014 年美国食品和药物管理局（FDA）发布关于睾丸激素安全性的通告后，停药率增加了 40%，与其他因素无关（P = 0.06）。
鉴于艾滋病毒感染者 TTh 使用和 CVD 风险均较高，应在未来研究中对老年艾滋病毒感染者进行 TTh 的益处和风险进行评估，并在临床实践中常规监测。
