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Hypogonadism is common and occurs prematurely in human immunodeficiency virus (HIV)-infected men, the prevalence being around 25% in young to middle-aged men with HIV.
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Hypogonadotropic hypogonadism due to hypothalamic-pituitary dysfunction is more frequent than primary hypergonadotropic hypogonadism in HIV-infected men.
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Signs and symptoms of hypogonadism become less specific in men with HIV because of the overlap with signs and symptoms of the HIV infection and do not help in ruling out the
Endocrinology and Metabolism Clinics of North America
Hypogonadism in the HIV-Infected Man
Section snippets
Key points
Epidemiology
The reported prevalence of hypogonadism among HIV-infected men varies depending on both the definition and the type of T measurement used and study dates. Since the introduction of HAART, HIV-infected men are living longer and their health status has improved in accordance with the changed spectrum of comorbidities.5, 6 For that reason, prevalence data of male hypogonadism are reported here according to the pre-HAART and post-HAART periods.
Pathogenesis of male hypogonadism in men with HIV
The pathogenesis of hypogonadism in HIV-infected men remains unclear. Hypothesis on the underlying causes and mechanisms have been provided based on some well-recognized pathophysiologic phenomena, but their cause-effect relationships need to be substantiated by further evidence.40 The authors provide the state of the art on known risk factors and predictor of T deficiency, as well as on pathophysiologic issues that contribute the genesis of hypogonadism in men with HIV infection.
Diagnosis
The diagnostic approach to male hypogonadism in HIV-infected patients should be based on a medical interview to obtain information on both patient’s health status and symptoms and on clinical examination, as in the general population.50 All these information should be thereafter integrated with and substantiated by biochemical testing.18, 50, 65
Treatment
Decision making concerning the selection of candidate for T replacement is difficult because the interpretation of signs, symptoms, and serum T levels is complex in HIV-infected men. Treatment should be started in all patients with severe T deficiency (total T<100 ng/dL or free T<30 ng/dL). Patients with slightly decreased serum T levels could be monitored and a wait-and-see approach might lead T prescription, especially if a progressive further decrease in T level occurs. Borderline low serum
Current controversies
The best way for the diagnosis of male hypogonadism in men with HIV remains to be precisely defined (see previous paragraph for details).
Screening of male hypogonadism is not recommended in the general population. Due to the elevated prevalence of hypogonadism among HIV-infected men, screening for T deficiency might be useful to identify patients who need replacement treatment. However, if the difficulties in making the diagnosis, the risk of overtreating patients who do not need T replacement,
Summary
The management of male hypogonadism needs a multidisciplinary approach involving both the specialist in HIV medicine and the endocrinologist (or andrologist). Based on extensive clinical experience in the management of endocrine disease in patients with HIV infection, the authors organized this multidisciplinary evaluation by providing endocrinological outpatients service directly within the clinic of infectious disease where patients are referred to. This or other similar kind of
Acknowledgments
The authors are indebted to Giulia Brigante, MD, PhD, and Chiara Diazzi, MD, PhD, for their help in searching the literature for useful resources and for their continuous support in the clinical management of HIV-infected patients. They thank Chiara Diazzi, MD, PhD, for technical support in painting digital pictures.
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2022, Sexual MedicineCitation Excerpt :Hypogonadism can be manifested as osteoporosis, SD, decreased libido, reduced body mass, and depression.36 Likewise, such symptoms of hypogonadism can overlap with those of HIV infection.37 In middle-aged and elderly men without HIV low prolactin levels are related to psychological symptoms, unhealthy metabolic phenotypes, and SD38; these findings may indicate how low prolactin levels impact sexual health in PLHIV.
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2021, Vitamins and HormonesCitation Excerpt :Estrogens strongly inhibit the secretion of gonadotropins (Rochira et al., 2000, 2006), acting at both hypothalamus and pituitary levels, thus an over-expression of aromatase can lead to hypogonadotropic hypogonadism through the increased production of estrogens (Rochira & Carani, 2017; Rochira et al., 2006) (Table 2). Therefore, the excess of body fat (and especially visceral fat) that characterizes obesity and/or the alterations of body fat distribution such as in obesity (Cohen, 2001; Kelly & Jones, 2015; Russell & Grossmann, 2019) and in the Human Immunodeficiency Virus (HIV)-related lipodystrophy (Rochira & Guaraldi, 2014) is associated to over-expression of aromatase and increased production of estrogens, this latter leading to inhibition of gonadotropins incretion (Rochira & Guaraldi, 2014; Rochira et al., 2000, 2006). Many drugs can determine the onset of hypogonadism through both central and/or testicular impairment (Table 2).
Pregnane steroidogenesis is altered by HIV-1 Tat and morphine: Physiological allopregnanolone is protective against neurotoxic and psychomotor effects
2020, Neurobiology of StressCitation Excerpt :Approximately 25% of HIV+ patients experience dysfunction of the hypothalamic-pituitary-gonadal (HPG; e.g., hypogonadism) and/or hypothalamic-pituitary-adrenal (HPA) axes (e.g., elevated basal corticosterone with adrenal insufficiency in response to HPA activation; Chrousos and Zapanti, 2014; George and Bhangoo, 2013; Gomes et al., 2017; Lachâtre et al., 2017; Mirza et al., 2018; Wong et al., 2017). In the era of combined antiretroviral therapy, HPG and HPA disruption typically involve dysfunction within the CNS, rather than dysfunction at peripheral steroid sources such as the gonads or adrenals (Bons et al., 2013; Chrousos and Zapanti, 2014; Freda and Bilezikian, 1999; Rochira and Guaraldi, 2014; Mirza et al., 2018). In support, others have found evidence of neurosteroidogenic dysregulation in post-mortem HIV+ brain tissue, cultured human fetal neurons, and the brains of cats infected with feline immunodeficiency virus (Maingat et al., 2013).
Laboratory assessment of acquired immunodeficiency syndrome endocrinopathies
2020, Handbook of Diagnostic Endocrinology
Disclosure: The authors have nothing to disclose.