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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

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.

References

  1. 1.

    BHASIN S., STORER T.W., JAVANBAKHT M. et al.: Testosterone replacement and resistance exercise in HIV-infected men with weight loss and low testosterone levels. J. Am. Med. Ass., 2000, 283: 763–770.

  2. 2.

    CHABON A.B., STENGER R.J., GRABSTALD H.: Histopathology of testis in acquired immune deficiency syndrome. Urology, 1987, 29: 658–663.

  3. 3.

    CHLEBOWSKI R.T., GROSVENOR M.B., BERNHARD N.H., MORALES L.S., BULCAVAGE L.M.: Nutritional status, gastrointestinal dysfunction, and survival in patients with AIDS. Am. J. Gastroenterol., 1989, 84: 1288–1293.

  4. 4.

    CHRISTEFF N., GHARAKHANIAN S., THOBIE N., ROZENBAUM W., NUNEZ E.A.: Evidence for changes in adrenal and testicular steroids during HIV infection. J. Acquir. Immune Defic. Syndr., 1992, 5: 841–846.

  5. 5.

    CORCORAN C., GRINSPOON S: Treatments for wasting in patients with the acquired immunodeficiency syndrome. N. Engl. J. Med., 1999, 340: 1740–1750.

  6. 6.

    Council of State and Territorial Epidemiologists, AIDS Program, Center for Infectious Diseases, Centers for Disease Control. Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome. MMWR, 1987, 36 (suppl 1): 3S-15S.

  7. 7.

    DANOFF A.: Endocrinologic complications of HIV infection. Med. Clin. North Am., 1996, 80: 1453–1469.

  8. 8.

    DE PAEPE M.E., WAXMAN M.: Testicular atrophy in AIDS: a study of 57 autopsy case. Hum. Pathol., 1989, 20: 210–214.

  9. 9.

    DOBS A.S., DEMPSEY M.A., LADENSON P.W. POLK B.F.: Endocrine disorders in men infected with human immunodeficiency virus. Am. J. Med., 1988, 84: 611–616.

  10. 10.

    DOBS A.S., FEW W.L., 3RD, BLACKMAN M.R., HARMAN S.M., HOOVER D.R., GRAHAM N.M.: Serum hormones in men with human immunodeficiency virus-associated wasting. J. Clin. Endocrinol. Metab., 1996, 81: 4108–4112.

  11. 11.

    DOBS A.S.: Is there a role for androgenic anabolic steroids in medical practice? J. Am. Med. Ass., 1999, 281: 1326–1327.

  12. 12.

    GRINSPOON S.K., BILEZIKIAN J.P.: HIV disease and the endocrine system. N. Engl. J. Med., 1992, 327: 1360–1365.

  13. 13.

    GRINSPOON S., CORCORAN C., LEE K. et al.: Loss of lean body and muscle mass correlates with androgen levels in hypogonadal men with acquired immunodeficiency syndrome and wasting. J. Clin. Endocrinol. Metab., 1996, 81: 4051–4058.

  14. 14.

    GRINSPOON S., CORCORAN C., ASKARI H. et al.: Effects of androgen administration in men with the AIDS wasting syndrome. A randomized, double-blind, placebo-controlled trial. Ann. Intern. Med., 1998, 129: 18–26.

  15. 15.

    GRINSPOON S., CORCORAN C., ANDERSON E. et al.: Sustained anabolic effects of long-term androgen administration in men with AIDS wasting. Clin. Infect. Dis., 1999, 28: 634–636.

  16. 16.

    KOTLER D.P., TIERNEY A.R., WANG J., PIERSON R.N. JR.: Magnitude of body-cell-mass depletion and the timing of death from wasting in AIDS. Am. J. Clin. Nutr., 1989, 50: 444–447.

  17. 17.

    LAUDAT A., BLUM L., GUECHOT J. et al.: Changes in systemic gonadal and adrenal steroids in asymptomatic human immunodeficiency virus-infected men: relationship with the CD4 cell counts. Eur. J. Endocrinol., 1995, 133: 418–424.

  18. 18.

    MERENICH J.A., MCDERMOTT M.T., ASP A.A., HARRISON S.M., KIDD G.S.: Evidence of endocrine involvement early in the course of human immunodeficiency virus infection. J. Clin. Endocrinol. Metab., 1990, 70: 566–571.

  19. 19.

    MHIRI C., BELEC L., DI COSTANZO B., GEORGES A., GHERARDI R.: The slim disease in African patients with AIDS. Trans. R. Soc. Trop. Med. Hyg., 1992, 86: 303–306.

  20. 20.

    MYLONAKIS E., KOUTKIA P., GRINSPOON S.: Diagnosis and treatment of androgen deficiency in human immunodeficiency virus-infected men and women. Clin. Infect. Dis., 2001, 33: 857–864.

  21. 21.

    PORETSKY L., CAN S., ZUMOFF B.: Testicular dysfunction in human immunodeficiency virus-infected men. Metabolism, 1995, 44: 946–953.

  22. 22.

    PRALONG F.P., CASTILLO E., RAPOSINHO P.D., AUBERT M.L., GAILLARD R.C.: Obesity and the reproductive axis. Ann. Endocrinol. (Paris), 2002, 63: 129–134.

  23. 23.

    RAFFI F., BRISSEAU J.M., PLANCHON B., REMI J.P., BARRIER J.H., GROLLEAU J.Y.: Endocrine function in 98 HIV-infected patients: a prospective study. Aids, 1991, 5: 729–733.

  24. 24.

    RIETSCHEL P., CORCORAN C., STANLEY T., BASGOZ N., KLIBANSKI A., GRINSPOON S.: Prevalence of hypogonadism among men with weight loss related to human immunodeficiency virus infection who were receiving highly active antiretroviral therapy. Clin. Infect. Dis., 2000, 31: 1240–1244.

  25. 25.

    SHEVCHUK M.M., NUOVO G.J., KHALIFE G.: HIV in testis: quantitative histology and HIV localization in germ cells. J. Reprod. Immunol., 1998, 41: 69–79.

  26. 26.

    SHEVCHUK M.M., PIGATO J.B., KHALIFE, G., ARMENAKAS N.A., FRACCHIA J.A.: Changing testicular histology in AIDS: its implication for sexual transmission of HIV. Urology, 1999, 53: 203–208.

  27. 27.

    VAN TYLE J.H.: Ketoconazole. Mechanism of action, spectrum of activity, pharmacokinetics, drug interactions, adverse reactions and therapeutic use. Pharmacotherapy, 1984, 4: 343–373.

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Correspondence to François Fralong.

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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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Mots-clés

  • VIH
  • testostérone
  • hypogonadisme
  • perte de poids

Key words

  • HIV
  • testosterone
  • hypogonadism
  • weight loss