Long-term Testosterone Replacement Ups Risk of Cardiovascular Events, Death in HIV+ Men

SAN DIEGO, CA—Long-term testosterone replacement therapy (TRT) is associated with an increased risk of cardiovascular events (CVE) and death among HIV-positive men, authors of a retrospective chart review reported at IDWeek 2015.

“There was a six-fold increase in the odds of having a new CVE in HIV-positive men when taking TRT for greater than 6 months,” reported lead study author Rahwa Ghebremichael, MPH, Oregon Health & Science University, Portland, Oregon, and coauthors.

TRT is administered to HIV-positive men to treat hypogonadism.

“Recent reports suggest that TRT may result in increased cardiovascular events,” Dr. Ghebremichael said. “However, few studies have evaluated the long-term effects of prolonged TRT use.”

To address that gap, the coauthors conducted a retrospective chart review at the Veterans Administration Portland Healthcare System's infectious disease clinic, reviewing long-term TRT and CVE incidence during the active-antiretroviral (ART) era for 56 patients administered TRT and 113 control-group patients.

“We identified all patients who received TRT for >6 months [median 2.8 years] from 2000–2013,” Dr. Ghebremichael said. “The comparison group was randomly selected with a 2:1 ratio of HIV patients who never took TRT. The non-TRT group was group-level matched based on age and duration of HIV diagnosis and was from the same period.”

Baseline data was recorded for demographics, comorbidities, medications, labs, CV risk factors, and ART. TRT duration and adverse events (AE) were also recorded. The primary study outcomes were death and new CVE.

The coauthors identified 15 (26.8%) deaths among the 56 patients in the TRT group, versus 10 deaths (8.8%) among the 113 control-group patients (P=0.002), Dr. Ghebremichael reported.

“Incident CVE during the study interval was also significantly higher in the TRT group” (P<0.001), she reported. “The odds of having a new CVE was significantly associated with TRT (odds ratio [OR] 6.13; 95% CI: 1.92, 19.61; P=0.002),” even when controlling for antihypertensive therapy at baseline (OR 9.69; 95% CI: 2.52, 37.22; P=0.001), CD4 count <200 at baseline (OR 2.89; 95% CI: 0.84, 9.88; P=0.09), and use of abacavir (OR 2.89; 95% CI: 0.99, 9.01; P=0.056).

“Prolonged TRT use may compound the effect of other underlying cardiac risk factors and may need to be considered in this population,” the authors concluded. “We are currently analyzing these effects with survival models, taking into account time to new CVE or death.”

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