Hypogonadism and liver fibrosis in HIV-infected patients

E Quiros-Roldan; T Porcelli; L C Pezzaioli; M Degli Antoni; S Paghera; M Properzi; E Focà; C Carriero; F Castelli; A Ferlin

doi:10.1007/s40618-021-01512-9

Hypogonadism and liver fibrosis in HIV-infected patients

J Endocrinol Invest. 2021 Sep;44(9):1971-1979. doi: 10.1007/s40618-021-01512-9. Epub 2021 Jan 29.

Authors

E Quiros-Roldan¹, T Porcelli², L C Pezzaioli³, M Degli Antoni¹, S Paghera⁴, M Properzi¹, E Focà¹, C Carriero¹, F Castelli¹, A Ferlin⁵

Affiliations

¹ Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy.
² Endocrinology, Montichiari Hospital, ASST Spedali Civili Brescia, Montichiari, Brescia, Italy.
³ Unit of Endocrinology and Metabolism, Department of Clinical and Experimental Sciences, University of Brescia and ASST Spedali Civili Brescia, Viale Europa 11, 25123, Brescia, Italy.
⁴ Diagnostic Department, ASST Centro di Ricerca Emato-oncologica AIL (CREA), Spedali Civili di Brescia, Brescia, Italy.
⁵ Unit of Endocrinology and Metabolism, Department of Clinical and Experimental Sciences, University of Brescia and ASST Spedali Civili Brescia, Viale Europa 11, 25123, Brescia, Italy. alberto.ferlin@unibs.it.

Abstract

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.

Keywords: HIV; Hypogonadism; LH; Liver fibrosis; SHBG; Testosterone.

Publication types

Observational Study

MeSH terms

Aspartate Aminotransferases / blood
Cohort Studies
Cross-Sectional Studies
HIV Infections / complications*
HIV Infections / epidemiology
Humans
Hypogonadism / epidemiology
Hypogonadism / etiology*
Liver Cirrhosis / epidemiology
Liver Cirrhosis / etiology*
Luteinizing Hormone / blood
Male
Middle Aged
Prevalence
Retrospective Studies
Sex Hormone-Binding Globulin / analysis
Testosterone / blood

Substances

Sex Hormone-Binding Globulin
Testosterone
Luteinizing Hormone
Aspartate Aminotransferases