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Session 151
Poster Abstracts Erectile Dysfunction and Hypogonadism Friday, 1:30 - 3:30 pm Hall B |
Background: Disorders of the androgens are prevalent in
HIV-infected men. There is a controversy about an association of changes of
androgens and development of lipoatrophy.
Methods: We conducted a nested case control study of 99
ART-naïve HIV-infected men who started and continued a virologically
successful zidovudine (AZT)/lamivudine
(3TC)-based HAART for 2 years, during which 11 patients developed lipoatrophy. Of 128 patients in the Swiss HIV Cohort Study,
we randomly chose 88 controls. Serum levels of luteinizing
hormone (LH), follicle-stimulating hormone (FSH), free testosterone (FT), and dehydroepiandrosterone (DHEA) were measured in plasma
stored before the start of and 2 years later of unchanged HAART.
Results: Controls and cases did not differ with regard
to age, body mass index, plasma HIV RNA, or CDC stage. CD4 counts at HAART
start were higher in cases (median 440, IQR 173 to 556) than in controls (median
203, IQR 98 to 331), p = 0.04. At
HAART start age adjusted FT levels were low in 69 (70%); in those LH levels
were normal 48% and low in 43%. FSH levels were normal 83 (84%) and low in 12
(12%). These proportions did not differ significantly in cases and controls.
DHEA levels were high in 26 (30%) and normal in 58 (66%) of controls and high in
1 (9%) and normal in 8 (73%) of the cases (p
= 0.1). During 2 years of HAART significant changes of FT and FSH levels were
not observed. However, controls increased their DHEA levels by a median of 1.3
IU/L (IQR –0.6 to 5.0) (p for change
during HAART < 0.001) and differed in that from cases (p for change = 0.6). All cases showed an increase in LH levels (median
difference +2.9 IU/L, IQR 0.8 to 5.5, p
for change 0.003), while these consistent differences were not seen in control
(median change –0.1, IQR –0.9 to 1.06). The presence of protease inhibitors in
the regimen was not associated with any change. In a stepwise logistic
regression model including baseline hormone values, changes of hormone values,
age, body mass index, CD4 count, and HIV RNA development of lipoatrophy
was associated with an increase in LH levels during HAART (p = 0.001) and there was a trend of association with a decrease in
DHEA levels, lower body mass index, higher CD4 counts, higher HIV RNA, and
increasing age (p = 0.05 to 0.1).
Conclusions: Hypogonadism is
found in the majority in HIV-infected men and does not resolve during 2 years
of HAART. Development of lipoatrophy is associated
with particular changes in the gonadotropin-androgen
axis and characterised by an increase of LH levels and lack of increase of DHEA
levels during HAART.
Keywords: androgens; gonadotropins; lipoatrophy
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