Free testosterone for hypogonadism assessment in HIV-infected men.
Free testosterone for hypogonadism assessment in HIV-infected men.
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游离睾酮用于艾滋病毒感染男性性腺功能减退症的评估。
DOI：
10.1093/cid/ciu129
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
Brown,ToddT
中科院分区：
文献类型：
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作者：
Monroe,AnneK;Brown,ToddT
我们同意作者的观点，即HIV感染男性性腺功能减退症诊断的首选初始检测方法尚未明确确立，尽管该领域的专家已经提倡使用早晨游离睾酮（FT）作为HIV感染男性的初始检测方法长达10年[2]。HIV感染的男性具有升高的性激素结合球蛋白水平，这可以使总睾酮（TT）即使在睾酮产生不足的情况下也显示正常[3]。支持使用早晨FT对HIV感染男性性腺功能减退症进行初步诊断的临床数据很少。因此，我们最近使用多中心艾滋病队列研究的数据进行了分析[4]。数据分析来自> 500名未接受睾酮替代治疗的HIV感染和未感染男性，其中早晨TT和FT水平可用。7.2%的未感染艾滋病毒的男性和9.3%的感染艾滋病毒的男性存在生化性腺功能减退（FT< 50 pg/mL或TT< 300 ng/dL）。在患有生化性腺功能减退症的男性中（n= 46），34名HIV感染者中有11名TT正常，但FT低。相比之下，所有未感染艾滋病毒的男性都有低TT和低FT。我们的发现意味着，如果早晨TT单独作为HIV感染男性性腺功能减退症的初始诊断测试，三分之一的男性将被遗漏。我们还研究了TT正常但FT低的HIV感染男性与TT和FT均低的HIV感染男性的特征。丙型肝炎病毒（HCV）感染与TT正常但FT低显著相关。因此，如果使用TT，HIV/HCV合并感染的患者可能特别容易被遗漏。基于这些原因，我们建议将早晨FT作为HIV感染男性性腺功能减退症的初始诊断试验，以提高诊断敏感性。
We agree with the authors that the preferred initial assay for hypogonadism diagnosis in HIV-infected men has not been definitively established, although experts in the field have advocated using morning free testosterone (FT) as the initial assay in HIV-infected men for 10 years [2]. HIV-infected men have elevated sex hormone binding globulin levels, which can make total testosterone (TT) appear normal even in the setting of inadequate testosterone production [3]. Clinical data supporting the use of morning FT for initial diagnosis of hypogonadism in HIV-infected men have been sparse. Therefore, we recently performed an analysis using data from the Multicenter AIDS Cohort Study [4]. Data were analyzed from> 500 HIV-infected and-uninfected men not on testosterone replacement therapy in whom morning TT and FT levels were available. Biochemical hypogonadism (FT< 50 pg/mL or TT< 300 ng/dL) was present in 7.2% of HIV-uninfected men and 9.3% of HIV-infected men. Of the men with biochemical hypogonadism (n= 46), 11 of 34 of the HIV-infected men had normal TT but low FT. In contrast, all of the HIV-uninfected men had both low TT and low FT. The implication of our finding is that if morning TT alone were used as the initial diagnostic test for hypogonadism in HIV-infected men, one-third of the men would be missed.We also examined characteristics of the HIV-infected men who had normal TT but low FT compared with those who had both low TT and low FT. Hepatitis C virus (HCV) infection was significantly associated with having normal TT but low FT. Therefore, HIV/HCV-coinfected patients may be particularly likely to be missed if TT is used. For these reasons, we suggest using morning FT as the initial diagnostic test for hypogonadism in HIV-infected men to improve diagnostic sensitivity.