Hypogonadism and liver fibrosis in HIV-infected patients

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

doi:10.1007/s40618-021-01512-9

Reproductive Endocrinology · Ovarian Hormones

Hypogonadism and liver fibrosis in HIV-infected patients

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

Published September 2021 Journal of endocrinological investigation

DOI 10.1007/s40618-021-01512-9 PMID 33515211 PMC PMC8357638

RRM Academy Synopsis

Liver fibrosis scores track with higher SHBG in men with HIV

A retrospective study of 107 men with HIV and sexual symptoms found that higher liver fibrosis scores went with higher SHBG, a liver-made protein that binds testosterone. In this group, about 3 out of 10 men had hypogonadism. Compensated hypogonadism and forms with normal or low LH were the most frequent.

Key Findings

Hypogonadism was found in about 30% of the 107 men: overt hypogonadism in 15 of 107 (14%) and compensated hypogonadism in 17 of 107 (15.8%).
Normogonadotropic hypogonadism was the most frequent overt form (10 of 107, 9.3%). Men with secondary or normogonadotropic forms were significantly more often obese.
Men with compensated hypogonadism had longer HIV duration (p = 0.031), higher mean APRI (p = 0.035) and higher mean FIB-4 scores (p = 0.008) than the other groups.
SHBG correlated with both liver fibrosis scores: APRI (r = 0.331; p = 0.002) and FIB-4 (r = 0.211; p = 0.045).
After adjustment for age, BMI, HCV antibody status and HIV duration, SHBG remained linked to both scores (APRI p < 0.0001; FIB-4 p = 0.002).

Interpretation

The study is a retrospective, cross-sectional analysis from a single center, so it shows links at one point in time. The authors estimated fibrosis with blood-based scores (APRI and FIB-4). Liver biopsy and elastography were not used. No comparison group without HIV was included. Only 3 men had primary hypogonadism, too few to analyze. The authors suggest that liver fibrosis raises SHBG and that higher LH keeps testosterone in the normal range in compensated forms. Two thirds of these symptomatic men had no biochemical confirmation of any form of hypogonadism.

RRM Context

Restorative reproductive medicine checks both partners. It seeks the cause of an abnormal result before treating it. Here, compensated hypogonadism was linked to higher liver fibrosis scores. Secondary forms were linked to obesity. The authors note that testosterone therapy is usual for symptomatic hypogonadism unless a man wants fertility.

Our editorial summary of this paper, not the article's abstract.

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.

Topics

Reproductive Endocrinology › Ovarian Hormones › Androgens · Diagnostics › Hormone Testing › Serum Panels

M Degli Antoni

PMID 33515211 33515211 DOI 10.1007/s40618-021-01512-9 10.1007/s40618-021-01512-9 Quiros-Roldan et al. 2021, Quiros-Roldan 2021

Hypogonadism and liver fibrosis in HIV-infected patients

Liver fibrosis scores track with higher SHBG in men with HIV

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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