Keith Alcorn
Men living with HIV who receive testosterone therapy experience a faster progression to atherosclerosis, according to data reported in a study of gay and bisexual men in the Multicenter AIDS Cohort Study (MACS).
The findings were presented at the virtual Conference on Retroviruses and Opportunistic Infections (CROI 2020).
Cardiovascular risk studies in men have linked both testosterone therapy and low testosterone levels to an increased risk of cardiovascular disease. However, a recently published review of studies in the general population concluded that there was no increased risk of cardiovascular events for men receiving testosterone replacement therapy.
None of these studies included a defined subgroup of older men living with HIV. Testosterone therapy is prescribed to older men living with HIV who have testosterone deficiency and experience symptoms of hypogonadism, such as loss of muscle mass, loss of bone tissue, increased abdominal fat, or sexual dysfunction.
A 2015 review of testosterone prescriptions showed that HIV-positive men living in the United States were two and a half times more likely to receive it than HIV-negative men.
To better define the cardiovascular implications of testosterone therapy in men with HIV, Dr. Sabina Haberlen of the Johns Hopkins Bloomberg School of Public Health and her colleagues from the MACS study compared the progression of cardiovascular disease in 300 men in the cohort according to exposure to testosterone therapy.
The cohort participants were aged between 40 and 70 years, underwent baseline computed tomography scans between 2010 and 2013 and again between 2015 and 2017, a mean interval of 4.6 years.
The study compared the progression of subclinical cardiovascular disease, defined as the development or worsening of plaque and calcification in the coronary arteries. Both contribute to an increased risk of cardiovascular events by narrowing the arteries, reducing their flexibility, and causing the buildup of unstable plaques on the artery walls. These plaques can break off and obstruct an artery, leading to a heart attack or stroke.
Four groups were compared:
• Current users and those who were exposed to testosterone replacement therapy (TRT) in both scans (n = 53)
• New users, who started TRT after the first scan (n = 21)
• Former users who stopped TRT before the first scan (n = 24) (chosen as a second control since they had a previous indication for TRT)
• Men who had never used TRT (a control group, n = 211).
The groups were similar in most respects, except that the higher proportions of current users also had a higher risk of cardiovascular events (50% had >7.5% 10-year risk compared to 36-40% in other groups) and were taking cholesterol-lowering drugs (63% vs 43-52%).
Progression of plaque and calcium in the coronary arteries was more likely to occur in both new and ongoing users of testosterone therapy. Compared with previous users, new users had more than twice the risk of progression (non-calcified plaque: adjusted relative risk 2.16; coronary artery calcium: ARR 2.37) after adjusting for other cardiovascular risk factors.
Ongoing users also had a higher risk of progression of coronary artery calcium (aRR 1.99) but not of progression of non-calcified plaque.
Los niveles bajos de testosterona basales (<300ng / dl) también se asociaron con la progresión de calcio en las arterias coronarias (aRR 1.97, p <0.001) pero no con la placa no calcificada.
The researchers conclude that more evidence is needed on the impact of testosterone therapy on cardiovascular risk in men living with HIV. In the meantime, they say, cardiovascular risk-reduction interventions such as smoking cessation and cholesterol-lowering medications should be implemented for men taking testosterone therapy, in accordance with existing risk-reduction guidelines.
References
Haberlen S et al. Testosterone therapy and progression of subclinical atherosclerosis in men with HIV. Conference on Retroviruses and Opportunistic Infections, abstract 642, March 2020.
From: http://www.aidsmap.com/news/mar-2020/testosterone-therapy-linked-faster-progression-atherosclerosis-men-hiv