Hypogonadism and bone health in men with HIV

Maffezzoni, Filippo; Porcelli, Teresa; Delbarba, Andrea; Pezzaioli, Letizia Chiara; Properzi, Martina; Cappelli, Carlo; Castelli, Francesco; Quiros-Roldan, Maria Eugenia; Ferlin, Alberto

doi:10.1016/s2352-3018(20)30236-8

Cited by 19 publications

(21 citation statements)

References 66 publications

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“…On the other side, higher TT levels showed some protective role against VFs occurrence. With respect to BMD data, our findings for osteoporosis (34.5%) and osteopenia (53%) prevalence mainly agree with the literature, even if the prevalence of osteoporosis and osteopenia in HIV-infected men widely varies among studies ranging from 6 to 34% [1] and up to 67% [19,20], respectively. Of note, a component of iatrogenic hypophosphatemic osteomalacia may be present in these patients, as already reported [21].…”

Section: Discussionsupporting

confidence: 90%

Impact of hypogonadism on bone mineral density and vertebral fractures in HIV-infected men

Pezzaioli

Porcelli

Delbarba

et al. 2021

J Endocrinol Invest

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Purpose Hypogonadism and osteoporosis are frequently reported in HIV-infected men and, besides multifactorial pathogenesis, they might be directly linked because of testicular involvement in bone health. We evaluated the prevalence of osteoporosis and vertebral fractures (VFs) in HIV-infected men, and assessed their relationship with gonadal function. Methods We enrolled 168 HIV-infected men (median age 53). Osteoporosis and osteopenia were defined with T-score ≤ – 2.5SD and T-score between – 1 and – 2.5SD, respectively. VFs were assessed by quantitative morphometric analysis. Total testosterone (TT), calculated free testosterone (cFT), Sex Hormone Binding Globulin (SHBG), Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH) were obtained; overt hypogonadism was defined on symptoms and low TT or cFT, and classified into primary and secondary according to gonadotropins; compensated hypogonadism was defined as normal TT and cFT with high LH levels. Results Overall, osteoporosis and osteopenia were found in 87.5% of patients, and VFs were detected in 25% of them; hypogonadism was identified in 26.2% of cases. Osteoporotic patients had higher SHBG vs those with normal bone mineral density (BMD). Fractured patients were more frequently hypogonadal and with higher SHBG. SHBG showed negative correlation with both spine and femoral BMD, and positive correlation with VFs. In multivariate models, FSH showed negative impact only on femoral BMD, whereas older age and higher SHBG predicted VFs. Conclusion We found a high burden of bone disease and hypogonadism in HIV-infected men, and we showed that the impact of gonadal function on bone health is more evident on VFs than on BMD.

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Section: Discussionsupporting

confidence: 90%

Impact of hypogonadism on bone mineral density and vertebral fractures in HIV-infected men

Pezzaioli

Porcelli

Delbarba

et al. 2021

J Endocrinol Invest

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“…2). Finally, primary hypogonadism was uncommon (2.8%) in our cohort of middle-aged HIV-infected patients, in agreement with previous reports [28]. Although the low number of patients affected by primary hypogonadism did not allow us detailed analyses, this form seems not to be related with liver fibrosis.…”

Section: Discussionsupporting

confidence: 92%

“…Normogonadotropic hypogonadism is also called functional hypogonadism [22], indicating that low T levels occur in the absence of both intrinsic structural HPT axis pathology and of specific pathological conditions suppressing the HPT axis (e.g., prolactinoma). Indeed, HIV per se, obesity and increased SHBG are indicated as possible causes of functional hypogonadism [22,28].…”

Section: Discussionmentioning

confidence: 99%

“…Although the low number of patients affected by primary hypogonadism did not allow us detailed analyses, this form seems not to be related with liver fibrosis. In these cases, the primary testicular damage may be associated with a direct effect of HIV, opportunistic infections, long-term ART exposure and systemic inflammation on the testis [28] (Fig. 2).…”

Section: Discussionmentioning

confidence: 99%

“…Our study is the first to examine the possible involvement of liver dysfunction/fibrosis in hypogonadism among middle-aged HIV-infected patients, having also the advantage of considering LH levels as marker of hypothalamus-pituitary function and cFT as a more sensitive marker of hypogonadism than TT. Most of the studies on hypogonadism in patients with HIV-infection focused only on TT levels, very few included also gonadotropins, and none included liver fibrosis data [28].…”

Section: Discussionmentioning

confidence: 99%

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Hypogonadism and liver fibrosis in HIV-infected patients

Quirós-Roldán

Porcelli

Pezzaioli

et al. 2021

J Endocrinol Invest

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Purpose Hypogonadism is frequent in HIV-infected men and might impact on metabolic and sexual health. Low testosterone results from either primary testicular damage, secondary hypothalamic-pituitary dysfunction, or from liver-derived sex-hormone-binding-globulin (SHBG) elevation, with consequent reduction of free testosterone. The relationship between liver fibrosis and hypogonadism in HIV-infected men is unknown. Aim of our study was to determine the prevalence and type of hypogonadism in a cohort of HIV-infected men and its relationship with liver fibrosis. Methods We performed a cross-sectional retrospective study including 107 HIV-infected men (median age 54 years) with hypogonadal symptoms. Based on total testosterone (TT), calculated free testosterone, and luteinizing hormone, five categories were identified: eugonadism, primary, secondary, normogonadotropic and compensated hypogonadism. Estimates of liver fibrosis were performed by aspartate aminotransferase (AST)-to-platelet ratio index (APRI) and Fibrosis-4 (FIB-4) scores. Results Hypogonadism was found in 32/107 patients (30.8%), with normogonadotropic (10/107, 9.3%) and compensated (17/107, 15.8%) being the most frequent forms. Patients with secondary/normogonadotropic hypogonadism had higher body mass index (BMI) (p < 0001). Patients with compensated hypogonadism had longer HIV infection duration (p = 0.031), higher APRI (p = 0.035) and FIB-4 scores (p = 0.008), and higher HCV co-infection. Univariate analysis showed a direct significant correlation between APRI and TT (p = 0.006) and SHBG (p = 0.002), and between FIB-4 and SHBG (p = 0.045). Multivariate analysis showed that SHBG was independently associated with both liver fibrosis scores. Conclusion Overt and compensated hypogonadism are frequently observed among HIV-infected men. Whereas obesity is related to secondary hypogonadism, high SHBG levels, related to liver fibrosis degree and HCV co-infection, are responsible for compensated forms.

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