Testosterone Deficiency and Changes in Body Composition in Men Living with HIV

Introduction Testosterone Deficiency (TD) is common in men living with HIV (MLWHIV) and is associated with worse clinical outcomes. This study aimed to evaluate the frequency of TD in MLWHIV and factors potentially associated with this condition. Methodology This observational cross-sectional study included MLWHIV aged > 18 years receiving Antiretroviral Therapy (ART). Clinical and laboratory data were collected, and body composition, Bone Mass (BM), Lean Mass (LM), and Fat Mass (FM), were assessed using Dual-energy X-ray Absorptiometry (DXA). TD was defined as Total Testosterone (TT) <300 ng/dL and/or calculated Free Testosterone (cFT) <6.4 ng/dL (Vermeulen’s formula). Data are presented as median (interquartile range, IQR) and n (%). Results Eighty-four participants were included from May 2014 to August 2015. Median TT was 396.5 ng/dL (IQR 314.8–490.2), Sex Hormone-Binding Globulin (SHBG) 45.4 nmol/L (IQR 35.1–60.2), and cFT 6.6 ng/dL (IQR 5.3–7.4). TD prevalence was 22.6% by TT and 44% by cFT (p<0.001). Using the cFT criterion, participants with TD were older (50 vs 45 years, p<0.01), had higher prevalence of metabolic syndrome (27% vs 4.3%, p<0.01), increased waist circumference (21.6% vs 4.3%, p<0.05), and lower frequency of normal BM (37.5% vs 67.5%, p<0.05). No differences were observed in CD4 count, ART duration or type, LM, FM, or lipodystrophy. Conclusion In MLWHIV, the cFT criterion identified more cases of TD than TT alone. TD in this population is associated with altered bone mass, increased waist circumference, and a higher prevalence of metabolic syndrome, highlighting the importance of systematic evaluation using cFT.