SERUM HORMONES IN MEN WITH HUMAN IMMUNODEFICIENCY VIRUS-ASSOCIATED WASTING

Weight loss is commonly associated with increased morbidity and mortal ity in individuals with human immunodeficiency virus (HIV) infection. We performed a nested case-control study of 26 HIV-infected subjects r ecruited from a cohort of gay men enrolled in the Multicenter Acquired Immunodeficiency Syndrome Cohort Study. To test the hypothesis that h ormonal changes precede and may induce the wasting syndrome, we perfor med a nested case-control study and analyzed serum gonadal steroids an d GH in samples of HIV-infected men with or without weight loss, uncom plicated by diarrhea or ever having an opportunistic infection. We stu died 13 cases (mean age +/- SD, 45 +/- 7.2 yr) with a mean weight loss of 13 +/- 3.6%, considered to have the wasting syndrome by Centers fo r Disease Control criteria (weight loss of >10%) and 13 controls match ed for age and duration of follow-up. Serum bioavailable testosterone (T) levels decreased in the case group (P < 0.05) before the definitio n of wasting was attained, although weight loss had already begun. Mor e impressive declines occurred in serum T (P = 0.012), free T (P = 0.0 025), and bioavailable T (P < 0.0001) during the 6 months immediately before documentation of wasting. These changes were concurrent with an increase in serum FSH (P = 0.0135) without a change in serum LH. We c onclude that a decline in bioavailable T occurs early in the course of events leading to wasting, suggesting that changes in gonadal hormone s may contribute to the multifactorial etiology of the wasting syndrom e.