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Published on: August 12, 2016
Testosterone replacement therapy among HIV-infected men in the CFAR Network of Integrated Clinical Systems
Ramona Bhatia1, Adam B Murphy, James L Raper
1aInstitute for Public Health and Medicine, Northwestern University, Chicago bDepartment of Urology, Northwestern University, Chicago, Illinois cDepartment of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama dDivision of HIV/AIDS, San Francisco General Hospital, University of California, San Francisco, California eDepartment of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, Washington fDepartment of Global Health and Population, Fenway Community Health Center of Harvard University, Boston, Massachusetts gDepartment of Medicine, Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina hDivision of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland iDepartment of Medicine, Division of Infectious Diseases, Northwestern University, Chicago, Illinois, USA.
Objective:
The objectives of this study were to determine the rate of testosterone replacement therapy (TRT) initiation, TRT predictors and associated monitoring in HIV-infected men.
Design:
A multisite cohort study.
Methods:
We examined TRT initiation rates and monitoring among adult HIV-infected men in routine care at seven sites in the Centers for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) from 1996 to 2011. We determined TRT predictors using Cox regression modelling.
Results:
Of 14 454 men meeting inclusion criteria, TRT was initiated in 1482 (10%) with an initiation rate of 19.7/1000 person-years [95% confidence interval (95% CI) 18.7-20.7]. In the multivariable model, TRT was significantly associated with age at least 35 years, white race, diagnosis of AIDS wasting, hepatitis C coinfection, protease inhibitor based antiretroviral therapy and nadir CD4 cell count of 200 cells/μl or less. Overall, 1886 out of 14 454 (13%) had testosterone deficiency. Among those initiating TRT, 992 out of 1482 (67%) had a pre-TRT serum total testosterone measured, and deficiency [<300 ng/dl (10.4 nmol/l)] was found in 360 out of 1482 (24%). Post-TRT serum total testosterone was measured within 6 months of TRT initiation in 377 out of 1482 (25%) men.
Conclusion:
TRT was common in HIV-infected men, though evidence for pre-TRT testosterone deficiency was lacking in 76%. Endocrine guidelines for post-TRT monitoring were uncommonly followed. Given cardiovascular and other risks associated with TRT, efforts should focus on understanding factors driving these TRT practices in HIV-infected men.