by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer

July 5, 2022

Featured Literature:
Eu B, Dawe J, Dunn M, et. al. Are there additional adverse effects of testosterone use among men living with HIV? Data from the PUSH! study. HIV Med. 2022 Jul 2. doi: 10.1111/hiv.13354. PMID: 35778978

This brief report from PUSH! study investigators in Australia describes clinical indicators of adverse effects from patient case records involving men living with and without HIV on either prescribed testosterone or who reported use of non-prescribed testosterone. The PUSH! study was a cross-sectional study conducted between 2019 and 2021 and involved review of patient management systems data from nine primary care clinics serving PWH in 5 cities. Data from 107 men with HIV (mean age 58 years) was compared to data from 106 men without HIV (mean age 52.3 years): overall, no statistically significant differences were observed in hemoglobin, total cholesterol, polycythemia, and abnormal liver function tests. Men with HIV were noted to have lower hematocrit (45.8% vs. 47.9%) and lower rates of hypertension (17.9% vs. 39.1%). Among the subgroup of only men using non-prescribed testosterone, a similar difference in hematocrit was observed (i.e. hematocrit was 45.3% for men with HIV vs. 48.8% for men without HIV).

Author’s Commentary:

Androgen deficiency continues to affect a number of men aging with HIV—a proportion of men go on to receive prescribed testosterone if indicated and desired (and others may opt to use non-prescribed testosterone for performance- and/or image-enhancement).  Because of the association between testosterone use and multiple potential adverse effects (e.g., erythrocytosis, elevated cardiovascular risk including hypertension and hyperlipidemia, prostate disease) – and generalized high prevalence of multimorbidity among PWH, a more detailed understanding of testosterone use and associated comorbidity among men with HIV may help providers and patients make individualized decisions about the risks and benefits of testosterone use.  Although this analysis involved cross sectional review of medical charts for a modest number of men, no significant differences in key adverse effects was observed.  Specifically, authors did not find increased rates of polycythemia, hyperlipidemia, liver function abnormalities, and hypertension in men living with HIV.

The author has no conflicts of interest to disclose.

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