HIV Antiretroviral Therapy And It's Effects on Reproductive Hormone Levels in Men Living With HIV at KNH

Background

Testosterone is the principal male hormone that determines male fertility and controls spermatogenesis. Metabolic abnormalities, infections and some medications are known to affect testosterone secretion and, therefore, male fertility. Infection with the human immunodeficiency virus (HIV) has been associated with endocrine abnormalities such as hypogonadism leading to male infertility. The use of antiretroviral drugs ameliorates the virulence of HIV hence development of AIDS. However, rates of male infertility are still high among HIV positive patients on ARVs compared to HIV negative males. This study hypothesizes that long term use of antiretroviral drugs by HIV infected male patients could affect production of male androgenic hormones that potentially result in infertility. 

Objectives

The overall aim of this study was to determine the effects of combined antiretroviral therapy on reproductive hormone levels among HIV positive adolescents and young adult males receiving care at Kenyatta National Hospital - Comprehensive Care Clinic. 

Methodology

This study enrolled 70 participants out of whom 34 were HIV negative and 36 HIV positive. The mean age of participants was 21 years with the mean period of HIV treatment being 13 years. This comparative cross-sectional study enrolled adolescent and young adult males aged between 15 and 25 years. HIV negative participants were the reference group while HIV positive were the test group. Laboratory assays were used to gather data on serum levels of testosterone, progesterone and luteinizing hormones (LH), as well as viral load and levels of CD4 count.  Data was analysed using T-test to compare means of continuous variables between study groups.  ANOVA was used to compare means of hormones among subject groups. Regression analysis was used to test associations between viral load and serum hormonal levels. 

Results

The majority (85%) of HIV infected participants were prescribed TDF/3TC/DTG drug combination. Hormonal levels of HIV positive and HIV negative participants was within normal ranges though slightly elevated among HIV positive participants. A significant difference in levels of LH between the two groups (10.29[SEM 3.92] vs 7.53[SEM 3.16], P=0.002) was observed. ART regimen used did not have an influence hormonal levels. Regression analysis found a significant association between level of progesterone (p=0.004) and testosterone (p=0.038).

Conclusion

Levels of progesterone, testosterone and LH were slightly elevated among HIV positive participants as compared to HIV negative participants suggesting compensated hypogonadism in HIV positive participants. 
Significance of study: ART affects male reproductive hormones even though the ranges are within the normal values on the higher side.   

Key words

Human Immunodeficiency Virus, Reproductive Hormones, Male infertility, Antiretroviral Therapy, Adolescent.