Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy.
Eur J Endocrinol. 2021 Jan;184(1):107-122. doi: 10.1530/EJE-20-0855.
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.
Prospective, cross-sectional, observational study.
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.
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 (R2 = 0.057, P < 0.0001) and TT (R2 = 0.013, P = 0.043), and directly related to E1 (R2 = 0.171, P < 0.0001), E2 (R2 = 0.041, P = 0.004) and E2/TS ratio (R2 = 0.104, P < 0.0001).
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.
HIV 感染男性中普遍存在性腺功能减退症。在 HIV 中，健康状况、性激素和身体成分之间的关系知之甚少。本研究旨在调查年轻到中年 HIV 感染男性的健康状况（合并症/虚弱）、身体成分和性腺功能之间的关系。
前瞻性、横断面、观察性研究。
招募年龄<50 岁且持续接受高效抗逆转录病毒治疗的 HIV 感染男性。通过液相色谱-串联质谱法测量血清总睾酮（TT）、雌二醇（E2）、雌酮（E1），通过免疫测定法测量 LH 和 FSH。通过 Vermeulen 方程计算游离睾酮（cFT）。通过双能 X 射线吸收法和腹部 CT 扫描评估身体成分。多发性合并症（MM）和虚弱分别定义为≥3 种合并症和 37 项指数。
共纳入 316 名年龄 45.3±5.3 岁的 HIV 感染男性。体脂参数与 cFT 和 TT 呈负相关，与 E1 和 E2/TS 比值呈正相关。患有 MM 的患者 cFT（P<0.0001）和 TT（P=0.036）降低，E1（P<0.0001）和 E2/TS 比值（P=0.002）升高。虚弱与 cFT（R2=0.057，P<0.0001）和 TT（R2=0.013，P=0.043）呈负相关，与 E1（R2=0.171，P<0.0001）、E2（R2=0.041，P=0.004）和 E2/TS 比值（R2=0.104，P<0.0001）呈正相关。
较低的 TT 和 cFT、较高的 E1、E2/TS 比值和内脏脂肪与较差的健康状况和虚弱独立相关，可能是成年 HIV 感染男性健康状况不佳的标志。总体而言，MM、虚弱和体脂质量彼此之间以及与性激素密切相关，共同导致 HIV 男性功能性性腺功能减退症。
