Yoshino Yusuke, Koga Ichiro, Misu Keita, Seo Kazunori, Kitazawa Takatoshi, Ota Yasuo
Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.
Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.
J Infect Chemother. 2019 Apr;25(4):318-321. doi: 10.1016/j.jiac.2018.09.007. Epub 2018 Oct 4.
The prevalence of hypogonadism in HIV patients is still a matter of debate. Today, serum free testosterone (fTST) is thought to be more important than serum testosterone in the diagnosis of hypogonadism in patients with HIV. This study aimed to determine the prevalence of low fTST levels and the effects of anti-retroviral therapy (ART) on fTST levels in treatment-naïve male Japanese patients with HIV.
Patients who visited Teikyo University Hospital, Japan between 2010 and 2016 were enrolled. Patients' fTST levels were evaluated twice with a radioimmunoassay in the morning, at the onset of ART and one year later. Clinical factors were also reviewed. The patients were divided into two groups ('hypogonadism' and 'normal') based on Japanese criteria. To determine factors related to low fTST in treatment-naïve patients, the Mann-Whitney U test and a multiple-regression analysis were used. Changes in fTST levels after ART initiation were evaluated with a paired t-test.
Data from 25 patients were collected. Their median age was 36.0 years, and the median fTST level was 8.00 pg/ml in the treatment-naïve state. Thirteen patients (52%) were in the hypogonadism group. Low levels of fibroblast growth factor 23 were significantly related to low fTST levels. After the start of ART, fTST levels increased significantly (median 8.00 interquartile range [6.40-9.70] to 9.60 [7.60-13.10] pg/ml, p = 0.0081).
Subnormal fTST levels occurred frequently among the present study patients in treatment-naïve settings. Free testosterone levels in patients with HIV were significantly increased one year after the start of ART.
性腺功能减退在HIV患者中的患病率仍存在争议。如今，血清游离睾酮（fTST）在HIV患者性腺功能减退的诊断中被认为比血清睾酮更为重要。本研究旨在确定初治的日本男性HIV患者中低fTST水平的患病率以及抗逆转录病毒疗法（ART）对fTST水平的影响。
纳入2010年至2016年间就诊于日本帝京大学医院的患者。在ART开始时及一年后，于早晨用放射免疫分析法对患者的fTST水平进行两次评估。同时回顾临床因素。根据日本标准将患者分为两组（“性腺功能减退”组和“正常”组）。为确定初治患者中与低fTST相关的因素，采用曼-惠特尼U检验和多元回归分析。用配对t检验评估ART开始后fTST水平的变化。
收集了25例患者的数据。他们的中位年龄为36.0岁，初治状态下的中位fTST水平为8.00 pg/ml。13例患者（52%）属于性腺功能减退组。成纤维细胞生长因子23水平低与低fTST水平显著相关。ART开始后，fTST水平显著升高（中位数从8.00四分位间距[6.40 - 9.70]升至9.60[7.60 - 13.10] pg/ml，p = 0.0081）。
在本研究的初治患者中，fTST水平低于正常的情况频繁发生。HIV患者开始ART一年后，游离睾酮水平显著升高。
