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CAC progression up in men with HIV on testosterone therapy

Elvira Manzano
10 Jun 2020
Men with HIV who are on testosterone therapy appear to have an elevated risk for significant coronary artery calcium progression (CAC) vs those who are not on it, according to a study released at CROI 20.

There is also a trend towards noncalcified plaque volume progression in this population.

“Hence, it would be prudent for clinicians to monitor closely cardiovascular risk factors and recommend interventions to lower cardiovascular risk among men with HIV on or considering testosterone therapy,” said lead investigator Dr Sabina Haberlen, assistant scientist at the Johns Hopkins Bloomberg School of Public Health, which is a part of the Johns Hopkins University in Baltimore, Maryland, US. [CROI 2020, abstract 642]

“The cardiovascular outcomes of long-term testosterone therapy use remain unclear in the HIV population,” she added. “Since 2015, the US FDA has required a warning about the potential increased risk of heart attack and stroke on all testosterone products. Yet none of the trials or observational studies in the evidence base to date includes a defined subgroup of men with HIV.”

Haberlen and team sought to investigate whether coronary atherosclerosis progression differs by testosterone use in men with HIV. They analysed 300 men aged 40–70 years with HIV from the CVD* ancillary study of the Multicentre AIDS Cohort Study, 15 percent of whom were on testosterone therapy, 7 percent were new users,  and 8 percent were former users who had stopped by the time of a follow-up scan.

At a mean follow-up of 4.5 years, testosterone users had elevated risk for CAC progression (adjusted risk ratio [adjRR], 1.99; p<0.05)  and so were new users [adjRR, 2.37) relevant to former users, Haberlen reported.

For noncalcified plaque progression, new users had higher risk (adjRR, 2.16; p<0.05) vs former users, but the same was not as high for ongoing users (adjRR, 1.52; p> 0.05).

“Surprisingly, the never-use group also had an elevated risk for progression compared with the former-use group, though not statistically significant,” Haberlen said.

There was also a relationship between baseline low serum total testosterone (<300 ng/dL) and CAC progression (adjRR, 1.97; p< .001), but none between low testosterone and noncalcified plaque progression (adjRR,0.97; p= 0.93).

Haberlen said theirs are the first HIV-specific data addressing testosterone therapy in subclinical  CVD outcomes in men with HIV. “And the risk of atherosclerosis progression was twice greater among current compared to former users, though we cannot rule out the possibility that these results are driven by residual differences between the groups rather than an effect of the testosterone therapy itself.”

However, she added that is notable that their findings are similar to those on subclinical atherosclerosis progression from the randomized controlled trials of testosterone conducted among older men with testosterone deficiency.

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06 Jul 2020
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