Background: HIV-infection is associated to premature decline of serum testosterone (T) and higher prevalence of hypogonadism. Hypogonadism seems to be more frequent in HIV-infected men with poor health status, however the relationship between health status, represented by frailty and comorbidities, and T serum levels is still to be well defined.
Aim: To evaluate the correlation between comorbidities, frailty and gonadal status in HIV-infected men by assessing circulating total T (TT) with the gold standard Isotopic Dilution-Liquid Chromatography-tandem Mass Spectrometry (ID-LC-MS/MS)
Methods: Prospective, cross-sectional, observational study on HIV-infected men with ongoing Highly Active Antiretroviral Therapy (HAART). TT was assessed by a validated in house ID-LC-MS/MS, while sex hormone-binding globulin (SHBG) was measured by Chemiluminescent Immunoassay. Free T (FT) was calculated by Vermeulen equation. Comorbidities (diabetes, chronic viral liver disease, dyslipidemia, obesity, hypertension, cardiovascular disease, low bone mineral density, neoplasia) were assessed by structured interviews, while frailty was calculated through the validated 72-items multimorbidity index. Statistical analysis: Parameters were not normally distributed. Correlations were performed using linear regression models. Subgroups analysis was performed after dividing patients according to quartiles of FT.
Results: 316 consecutive HIV-infected men were enrolled (mean age 45.6±5.6 years; average duration of HIV-infection 16.3±8.8 years). FT was significantly different among subgroups defined by the number of comorbidities; in particular, the greater was the number of comorbidities, the lower was the level of FT (p = 0.003). The prevalence of comorbidities across quartiles had an increasing trend from the quartile of highest FT levels to the quartile of lowest FT; chi-square test, however, did not show a significant difference between the quartiles. Frailty score correlated with age (p <0.0001), BMI (p = 0.003), duration of HIV infection (p< 0.0001) and FT (p = 0.038), but at multivariate regression analysis only duration of HIV-infection and BMI were predictive of frailty index score.
Conclusions: Lower FT levels are associated with multimorbidity and poor health status in HIV infected men and this association seems to be bidirectional, leading to a kind of vicious circle. FT seems to correlate with frailty, but other factors, and in particular the duration of infection, are stronger in predicting a frail condition in this clinical setting.