
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.

R. Ghebremichael,
None
M. Nyendak, None
G. Forrest, None