1649. Long Term Testosterone Replacement Therapy (TRT) use in HIV Patients and New Cardiovascular Events (CVE)
Session: Poster Abstract Session: HIV: Cardiovascular Disease in HIV
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • Testosterone poster ID Week 2015_FINAL.pdf (1.5 MB)
  • Background: Testosterone replacement therapy (TRT) is used in HIV positive males for hypogonadism. Recent reports suggest that TRT may result in increased cardiovascular events (CVE). However, few studies have evaluated the long term effects of prolonged TRT use. We reviewed long-term TRT use and CVE in HIV positive men during the active antiretroviral era (ART).

    Methods:

    A retrospective chart review was performed at the VA Portland Healthcare System Infectious Disease clinic. We identified all patients who received TRT for >6 months from 2000-2013. The comparison group was randomly selected with a 2:1 ratio of HIV patients who never took TRT (non-TRT group). The non-TRT group was group-level matched based on age and duration of HIV diagnosis and was from the same period. Baseline data included demographics, comorbidies, medications, labs, CV risk factors and ART. Duration of TRT and adverse events (AE) were also collected with primary outcomes being death and new CVE.

    Results:

    There were 57 patients on TRT (median 2.8 years, range 0.2-18.2 years) and 113 non-TRT evaluated. Table 1 highlights baseline factors and outcomes. 

    Factor

    TRT Group (N=57)

    Non-TRT group (N=113)

    P value

    Age (years)

    60 (34-80)

    58 (38-76)

    0.27

    BMI (kg/m2)

    25.6 (12.3-38.9)

    26 (18.9-38.3)

    0.36

    Diabetes

    17.5% (10)

    8.8% (10)

    0.1

    Hypertension

    42.1% (24)

    38.9% (44)

    0.7

    Heart Disease

    10.5% (6)

    5.3% (6)

    0.22

    Hyperlipidemia

    44% (25)

    28.3% (32)

    0.043

    Smoking

    49% (25)

    64.6% (73)

    0.06

    Abacavir use

    41.8% (23)

    20.2% (21)

    0.004

    Outcome

     

     

     

    Death- Any cause

    26.3% (15)

    8.8% (10)

    0.002

             - CV cause

    40% (6)

    10% (1)

    0.06

    New CVE

    30.4% (17)

    6.2% (7)

    <0.001

     

     

     

     

    There were 15/57 (26%) deaths in the TRT group vs 10/113 (8.8%), p=0.002. CVE was also significantly higher in the TRT group (p <0.001). Using logistic regression analysis, the odds of having a new CVE was significantly associated with TRT (OR=6.13, 95% CI=1.92,19.61, p=.002) even when controlling for antihypertensive therapy at baseline (OR=9.69, 95% CI=2.52,37.22, p=.001), CD4 count <200 at baseline (OR=2.89,CI=0.84,9.88,  p=0.09), and use of abacavir (OR 2.89,CI=0.99,9.01, P=0.056).

    Conclusion:

    There was a 6 fold increase in the odds of having a significant CVE in HIV positive men when taking TRT for greater than 6 months. Prolonged TRT use may compound the effect of other underlying cardiac risk factors and may need to be considered in this population.

    Rahwa Ghebremichael, MPH1, Jwan Mohammadi, MPH2, Melissa Nyendak, MD1 and Graeme Forrest, MBBS, FIDSA3,4, (1)Oregon Health & Science University, Portland, OR, (2)Infectious Diseases, Portland VA Medical Center, Portland, OR, (3)Dept of Medicine, Portland Veterans Administration Medical Center, Portland, OR, (4)Section of Infectious Disease, Department of Medicine, Oregon Health & Science University, Portland, OR

    Disclosures:

    R. Ghebremichael, None

    J. Mohammadi, None

    M. Nyendak, None

    G. Forrest, None

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