Hypogonadism among male patients with HIV at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: The prevalence of hypogonadism is slightly higher among male patients with HIV compared to the general population. It is a complication that has persisted despite improved health outcomes and prolonged survival with the advent of highly active antiretroviral therapy (HAART). Factors associated include; age, duration of HIV infection, opportunistic infections, malignancies, adverse drug effects, malnutrition and chronic inflammation. If left untreated, hypogonadism may result in erectile dysfunction (ED), depression, wasting and infertility. Early identification and treatment reverse these complications and improves quality of life. Objective: To determine the prevalence of hypogonadism among male patients with HIV at Moi Teaching and Referral Hospital (MTRH) and to assess them for erectile dysfunction and depression. Methods: A cross sectional study was conducted among male patients attending HIV clinics at MTRH between March and April 2018. Using a systematic random sampling technique, a total of 182 patients were enrolled into the study. Sociodemographic and clinical data was collected using questionnaires while ED and depression were assessed using the International Index of Erectile function 5 (IIEF-5) and Patient Health Questionnaire 9 (PHQ-9) respectively. Venous blood samples were obtained for laboratory estimation of serum Total Testosterone (TT) levels by direct immunoassay. Hypogonadism was defined by TT < 300 ng/ML. Continuous variables were summarised as means, medians and standard deviations while categorical variables were summarised as frequencies and interquartile ranges. Means were compared using independent samples t-test while medians were compared using Wilcoxon-rank sum test. Association between hypogonadism and categorical variables was analysed using Fischer’s exact test. Results: The mean age of participants was 47 years (SD: 7.8). The average systolic BP was 127 mmHg (SD 17.7). Forty-five patients (24.7%) had a BMI above 25.A total of 122 (67%) patients had been on HAART for at least 5 years. Most participants 162 (89%) were virally suppressed. The prevalence of hypogonadism was 5.5% (95% C.I:2.7, 9.9). Among those with hypogonadism, 40% manifested symptoms consistent with ED while 30% were symptomatic for depression. A small proportion (20%) had both ED and depression. Half of the patients with hypogonadism were asymptomatic. In the overall study population, an incidental proportion finding of 56% for ED and 44% for depression was observed. Advancing age (p=0.421) and duration on HAART (p=0.204) were not associated with hypogonadism. Alcohol use was associated with higher prevalence of hypogonadism (9.5%) compared to (2.0%) among the non-users of alcohol, p = 0.046. Association between hypogonadism and ED (p=0.336) or depression (p=0.516) was not statistically significant. Conclusion: The prevalence of hypogonadism among male patients with HIV is low. Close to one half of those with hypogonadism present with either ED or depression. Recommendation: Testing for hypogonadism should be considered among male patients attending HIV clinics at MTRH who present with ED, depression or both upon a high index of suspicion. A study exploring factors associated with ED and depression is recommended.