- Déficit Androgénique
- Androgènes et VIH
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Diagnostic et traitement du déficit en androgènes des patients infectés par le virus de l’immunodéficience humaine
Diagnosis and treatment of androgen deficiency in patients with human immune deficiency virus infection
Andrologie volume 13, pages 348–353 (2003)
Resume
La prévalence du déficit en androgènes parmi les hommes atteints par le virus de l’immunodéficience humaine (VIH) varie entre 35% et plus de 50%. L’hypogonadisme est le plus souvent d’origine centrale, secondaire à la maladie systémique, aux infections opportunistes, à la malnutrition ou parfois également aux traitements administrés. Depuis l’avènement de thérapies anti-rétrovirales efficaces, cette prévalence a diminué mais demeure significative, notamment parmi les patients souffrant d’un syndrome de perte de poids lié au VIH. Lors d’hypogonadisme associé à une perte de poids, il est en outre possible que le déficit en androgènes aggrave la perte de masse maigre. C’est l’une des raisons pour lesquelles il est indiqué de dépister l’hypogonadisme chez tout patient infecté par le VIH et souffrant d’une perte de poids importante.
La substitution hormonale des patients hypogonadiques infectés par le VIH est indiquée, qu’ils soient symptomatiques (diminution de la libido, impuissance) ou pas. En effet, le traitement hormonal améliore la composition corporelle, l’ostéoporose, la qualité de vie et l’humeur, et il induit également une augmentation de la masse corporelle maigre et de la résistance à l’effort de ces patients. Les alternatives de traitement que nous proposons peuvent alors être un schéma d’injections intramusculaires d’esters de testostérone ou l’application quotidienne de préparations transdermiques. Par contre, il n’a pas été démontré que le traitement par des analogues synthétiques de la testostérone du type oxandrolone ou nandrolone induise un effet bénéfique supplémentaire par rapport à la testostérone. Finalement, aucune étude n’a pu mettre en évidence un quelconque effet bénéfique de l’administration de testostérone à des patients eugonadiques infectés par le VIH et ce même en présence d’un syndrome de perte de poids lié au virus. La substitution hormonale n’est donc pas indiqué en dehors d’un contexte d’hypogonadisme avéré.
Abstract
Androgen deficiency is frequent among men infected by the human immune deficiency virus (HIV), with an estimated prevalence of between 35% and 50%. Primary testicular damage has been described, either due to the virus itself, opportunistic agents such as CMV,Toxoplasma gondii orMycobacterium avium intracellulare, or less frequently neoplastic invasion by lymphoma or in a context of Kaposi’s sarcoma. However, secondary hypogonadism remains a more frequent cause. Hypogonadotropic hypogonadism can be secondary to opportunistic infections, malnutrition, and sometimes even certain therapeutic agents. Since the introduction of highly active antiretroviral therapies, the prevalence of hypogonadism has substantially decreased. However, it remains a significant clinical problem, particularly among patients suffering from wasting, as androgen deficiency may aggravate the loss of lean body mass observed in the wasting syndrome of HIV patients. Screening for androgen deficiency is therefore indicated in HIV patients suffering from wasting, even in the absence of specific symptoms.
Androgen replacement therapy is justified in symptomatic (loss of libido, impotence) and asymptomatic patients with documented hypogonadism. We recommend replacement therapy with testosterone by subcutaneous or intramuscular injection. In the absence of specific symptoms, it should be remembered that testosterone replacement therapy of HIV-infected hypogonadic patients is associated with improvements in body composition and muscle strength, bone densitometry, quality of life and mood. Similar improvements have also been demonstrated in hypogonadic patients with wasting syndrome. Synthetic testosterone analogues such as oxandrolone or nandrolone do not seem to be more powerful than testosterone at replacement doses, and may be associated with more side effects, particularly severe hepatic dysfunction. In contrast, there is no proven benefit of androgen treatment of eugonadic HIV-infected patients, and the treatment of such patients with androgens, even in the presence of wasting, cannot be recommended.
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Communication au XIXo Congrès de la Société d’Andrologie de Langue Française, Genève, 12–14 décembre 2002.
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Fralong, F. Diagnostic et traitement du déficit en androgènes des patients infectés par le virus de l’immunodéficience humaine. Androl. 13, 348–353 (2003). https://doi.org/10.1007/BF03035202
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DOI: https://doi.org/10.1007/BF03035202