SAT-050 Low Serum Testosterone (T) Is Associated with Poor Health Status in Young to Middle-Aged Human Immunodeficiency Virus (HIV)-Infected Men
Authors: Vincentis Sara De , Decaroli Maria Chiara , Diazzi Chiara , Morini Fabio , Bertani Davide , Fanelli Flaminia , Mezzullo Marco , Santi Daniele , Tartaro Giulia , Baraldi Enrica , Tagliavini Simonetta , Pagotto Uberto , Guaraldi Giovanni , Rochira Vincenzo 
Published: May 2020

Abstract
BACKGROUND: The relationship between health status, defined by frailty and comorbidities, and serum T levels has been widely demonstrated in general population, while only one previous retrospective study has explored it in HIV-infected men1.
AIM: To investigate the association between frailty and gonadal status by assessing serum total T (TT) with Liquid Chromatography tandem Mass Spectrometry (LC-MS/MS) in a cohort of HIV-infected men.
METHODS: Prospective, cross-sectional, observational study on HIV-infected men (age &lt;50 years) with ongoing Highly Active Antiretroviral Therapy. Serum TT was assessed by the gold standard ID-LC-MS/MS. Sex hormone-binding globulin (SHBG) was measured by chemiluminescent immunoassay. Calculated free T (cFT) was obtained by Vermeulen equation. Multimorbidity was defined as at least 3 comorbid conditions, including: hypertension, diabetes, cardiovascular disease, chronic obstructive pulmonary disease, chronic kidney disease, osteoporosis, chronic viral hepatitis and cancers. Frailty was calculated through the validated 37-item frailty index (FI)2. Patients with FI&gt;0.21 were considered frail. Statistical analysis: Mann-Whitney U test was used to compare continuous variables. Correlations were performed using linear regression models.
RESULTS: 315 consecutive HIV-infected men were enrolled (mean age 45.3±5.3 years; average duration of HIV-infection 16.3±8.8 years). 128 patients (40.5%) were comorbid and 207 (64.9%) were frail. Either cFT (p=0.001) or TT (p&lt;0.001) were lower in comorbid patients than others. FT was inversely related to the number of comorbidities (p&lt;0.001, R2=0.045). Accordingly, cFT (p=0.003) and TT (p&lt;0.001) were significantly lower in frail patients. Frailty score was inversely correlated with cFT (p&lt;0.001, R2=0.058), TT (p=0.041, R2=0.014) and SHBG (p=0.003, R2=0.029). However, after adjustment for age and duration of HIV-infection, cFT, TT and SHBG were excluded from the regression model.
CONCLUSIONS: Low cFT and TT levels are associated with multimorbidity and poor health status in HIV infected men. The bidirectional nature of this relationship leads to the figuration of an intriguing vicious circle where T deficiency triggers the onset of comorbidities or, vice versa, poor health status induces hypogonadism. At the same time, notwithstanding the inverse relation between FT and frailty, it seems that other stronger predictive factors, and in particular the duration of infection, are involved in determining the health outcome in this clinical setting.
REFERENCES
1Rochira V et al. Low testosterone is associated with poor health status in men with human immunodeficiency virus infection: a retrospective study. Andrology. 2015 Mar;3(2):298-308.
2Guaraldi et al. A frailty index predicts survival and incident multimorbidity independent of markers of HIV disease severity. AIDS. 2015 Aug 24;29(13):1633-41.