Mechanisms and treatment of androgen deficiency in HIV disease

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Abstract
Hypogonadism is common among men with HIV disease, particularly among those with the AIDS wasting syndrome. The mechanisms of androgen deficiency in this population remain unknown but may relate to the effects of chronic illness per se, poor nutrition, cytokines, or specific drugs used in the treatment of HIV disease. Recent studies suggest that the prevalence of androgen deficiency among men with HIV disease remains increased, although to a lesser extent, in the current era of highly active antiretroviral therapy. Androgen therapy has now been established as an effective therapy to reverse muscle loss in men with AIDS wasting and is an important therapy in the management of such patients. Similarly, androgen deficiency is common among women with HIV disease, in whom androgen levels correlate with muscle mass and functional status. Preliminary studies indeed suggest a benefit of androgen replacement in HIV-infected women. Research is ongoing into the mechanisms of androgen deficiency and the therapeutic role of androgens in the management of HIV-infected patients, including the large population of HIV-infected women.