Adverse Consequences Of Low Testosterone Concentrations On Healthrelated Outcomes In Hivinfected Individuals

Low testosterone levels are associated with an adverse disease outcome in HIV-infected men. Serum testosterone levels are lower in HIV-infected men who have lost weight than in those whose weight has been stable (39). Longitudinal follow-up of HIV-infected homosexual men revealed a progressive decrease in serum testosterone levels (40). This decrease was much greater in HIV-infected men who progressed to AIDS than in those who did not. We do not know whether the decrease in testosterone levels is a consequence of weight loss or is a contributory factor that precedes muscle wasting. In a longitudinal study, Dobs et al. (41) measured serum testosterone levels in a cohort of HIV-infected men and reported that serum testosterone levels decline early in the course of events that culminate in wasting. Testosterone levels correlate positively with muscle mass and exercise capacity in HIV-infected men (2), leading to the speculation that hypogonadism may contribute to muscle wasting and debility. Although patients with HIV infection may lose both fat and lean tissue, the loss of lean body mass is an important aspect of the weight loss associated with wasting. The magnitude of depletion of nonfat tissues is an important determinant of the time of death in AIDS (42,43). In addition, fat-free mass is an important correlate of the health-related quality of life in HIV-infected individuals and in older men and women. There is also a high prevalence of sexual dysfunction in HIV-infected men (44,45). With the increasing life expectancy of HIV-infected men, frailty and sexual dysfunction have emerged as important quality-of-life issues.

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