TRT in HIV-Infected Men: The Need for Better Monitoring

Summary and Comment |
December 11, 2014

TRT in HIV-Infected Men: The Need for Better Monitoring

  1. Charles Hicks, MD

Data from a large multicenter cohort showed that testosterone-replacement therapy was commonly prescribed — often without pretreatment testing or posttreatment monitoring.

  1. Charles Hicks, MD

Prescription androgen use in the U.S. tripled between 2001 and 2011, by which time nearly 3% of men aged >40 were on testosterone replacement therapy (TRT). Researchers from the Centers for AIDS Research Network of Integrated Clinical Systems used data collected in seven HIV clinics between 1996 and 2011 to characterize TRT initiation and monitoring in HIV-infected men without evidence of prior testosterone use.

During 75,173 person-years of follow-up, TRT was initiated in 1482 of the 14,454 study participants (19.7/1000 person-years of follow-up, vs. 7.57/1000 person-years in the general population). In a multivariate model, factors significantly associated with TRT initiation were age ≥35, white race, diagnosis of AIDS wasting, hepatitis C virus coinfection, protease-inhibitor–based antiretroviral therapy, and nadir CD4 count <200 cells/mm3. Pretreatment testosterone levels were measured in 992 men (67% of those starting TRT), with testosterone deficiency documented in 360 (24%). After TRT initiation, 898 men (61%) had testosterone level measured at least once. Among men aged >40 at TRT initiation, 273/812 (34%) had pretreatment and 97 (12%) had posttreatment prostate-specific antigen (PSA) measurements.

Comment

Recent studies suggest TRT use may increase risks for myocardial infarction, stroke, thrombosis, and death; TRT overuse can also increase risks for erythrocytosis, metastatic prostate cancer, reduced sperm production, and infertility. Clinical practice guidelines from the Endocrine Society recommend establishing testosterone deficiency before — and monitoring serum testosterone levels after — TRT initiation. The overall TRT initiation rate in this population of HIV-infected men (of whom only 24% had laboratory-confirmed testosterone deficiency) was more than 2.5 times higher than that in U.S. men overall. Rates of pre- and posttreatment laboratory monitoring (testosterone, PSA) were low. Better adherence to guidelines for TRT in HIV-infected men is clearly needed.

Editor Disclosures at Time of Publication

  • Disclosures for Charles Hicks, MD at time of publication Consultant / Advisory board Bristol-Meyers Squibb; Gilead Sciences; Janssen Virology; ViiV; Merck Editorial boards UpToDate

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