Androgen Therapy in AIDS Wasting

Hypogonadism in HIV-infected men has been well described, having a prevalence of about 30%. Its aetiology is a combination of non-specific changes from chronic and acute illness, and specific effects due to HIV infection. A depressed serum testosterone level has been associated with viral or infectious invasion of the endocrine organs, and with medications commonly used in treating HIV infection. Recently, many have noted the association between decreased serum testosterone in men and women, and the wasting syndrome of HIV infection, particularly with a reduction in lean body mass. Our understanding of the risks and benefits of testosterone therapy in non-HIV infected men has grown significantly. Treatment in this population can improve sexual function, quality of life parameters and body composition. Based on this information, a few studies have been carried out, and more are being planned to test the hypothesis that therapy with testosterone or its analogues can benefit HIV-infected men and women with wasting and/or low circulating androgen concentrations. To date, the studies have been inconclusive. Not all studies have shown a statistical benefit of androgen therapy on weight, muscle mass or quality of life. Testosterone is now available in several forms for dosing, which has improved compliance and ease of administration. Its potential risk to the prostate or serum lipids should be monitored closely. Although the beneficial effects of androgenic steroids in HIV-infected men have not been demonstrated clearly, short-term studies suggest that testosterone supplementation may improve metabolic outcomes in HIV-infected men with androgen deficiency.