Iddi Shabani, Dika Haruna, Marwa Karol J, Kidenya Benson R, Kalluvya Samuel E
Department of Physiology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
Department of Pharmacology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
PLoS One. 2025 May 28;20(5):e0324374. doi: 10.1371/journal.pone.0324374. eCollection 2025.
Male hypogonadism is commonly reported in men living with human immunodeficiency virus (HIV) (MLWH), reaching a prevalence of up to 89% and shown to decrease in the antiretroviral therapy (ART) era as compared to pre-ART era. Data regarding the effect of ART on gonadal hormones levels are scarce. We aimed to determine changes in gonadal hormones levels in HIV males following ART initiation.
This was a longitudinal study involving newly diagnosed ART naïve MLWH in Mwanza, Tanzania. All enrolled participants underwent thorough clinical and physical examination including anthropometric measurements. A pre-structured questionnaire was used to collect socio-demographic and clinical data. Serum total testosterone (TT), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol were estimated at baseline, six and twelve months after ART initiation. Serum TT < 300 ng/dl, or ≥300 ng/dl with high LH and FSH were taken as markers of hypogonadism. Data were analyzed using STATA version 15.
A total of 213 participants were enrolled in this study. Between individual's pairs, the median levels of TT and LH after six and twelve months were found to be significantly higher while estradiol was significantly lower than at baseline (p < 0.001). Between after six and after twelve months, only median estradiol levels showed significant change with levels being lower after twelve months (p < 0.001). The change in FSH was not statistically significant. Of the 89 participants (41.8%) who had hypogonadism at baseline, 44 (49.4%) normalized TT (≥300 ng/ml) and had higher median testosterone than those who did not normalize. Furthermore, there was a statistically significant association between testosterone change and initial viral load (p = 0.049), WHO clinical stage (p = 0.031) and baseline hypogonadism status (p = 0.014).
This study concludes that TT improved significantly after ART initiation. Particularly, half of the MLWH who presented with low TT at baseline normalized it within the first year of treatment. Therefore, ART reduces prevalence of hypogonadism and baseline TT seems to be predictive of future evolution of the hypogonadism.
男性性腺功能减退在感染人类免疫缺陷病毒（HIV）的男性（MLWH）中普遍存在，患病率高达89%，并且与抗逆转录病毒治疗（ART）时代之前相比，在ART时代有所下降。关于ART对性腺激素水平影响的数据很少。我们旨在确定开始ART后HIV男性性腺激素水平的变化。
这是一项纵向研究，涉及坦桑尼亚姆万扎新诊断的未接受过ART的MLWH。所有登记参与者都接受了全面的临床和体格检查，包括人体测量。使用预先构建的问卷收集社会人口学和临床数据。在ART开始时、开始后6个月和12个月时估计血清总睾酮（TT）、促卵泡激素（FSH）、促黄体生成素（LH）和雌二醇。血清TT<300 ng/dl或≥300 ng/dl且LH和FSH升高被视为性腺功能减退的标志物。使用STATA 15版分析数据。
本研究共纳入213名参与者。在个体配对之间，发现6个月和12个月后的TT和LH中位数水平显著高于基线水平，而雌二醇显著低于基线水平（p<0.001）。在6个月后和12个月后之间，只有雌二醇中位数水平显示出显著变化，12个月后的水平较低（p<0.001）。FSH的变化无统计学意义。在基线时患有性腺功能减退的89名参与者（41.8%）中，44名（49.4%）的TT恢复正常（≥300 ng/ml），且其睾酮中位数高于未恢复正常的参与者。此外，睾酮变化与初始病毒载量（p=0.049）、世界卫生组织临床分期（p=0.031）和基线性腺功能减退状态（p=0.014）之间存在统计学显著关联。
本研究得出结论，开始ART后TT显著改善。特别是，基线时TT较低的MLWH中有一半在治疗的第一年内使其恢复正常。因此，ART降低了性腺功能减退的患病率，基线TT似乎可预测性腺功能减退的未来演变。
