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Supplemental Testosterone Contributes to Strength Differences in Men With vs Without HIV
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10th International Workshop on HIV and Aging, October 10-11, 2019, New York
Mark Mascolini
Compared with HIV-negative men in the US Multicenter AIDS Cohort Study (MACS), HIV-positive cohort members used supplemental testosterone more often, according to results of a 2575-man analysis [1]. Testosterone contributed to differences in grip strength, a frailty component, between men with and without HIV.
MACS investigators who conducted this study noted that grip strength wanes more rapidly in people with than without HIV infection. Probably because testosterone increases muscle mass, some studies have linked it to greater strength. The MACS team observed that older men with HIV often use testosterone, but its impact on muscle strength and physical function in these men remains uncertain. They conducted this comparison to explore the potential impact of testosterone supplementation on grip strength in men with or without HIV infection.
MACS enrolls men who have sex with men (MSM) with or at risk for HIV infection. Twice each year they make a study visit, which includes a measure of grip strength, one of the factors used to determine frailty. This analysis included HIV-positive or negative men who had at least 2 grip strength measurements between 2006 and 2018. MACS researchers used multivariate linear mixed models to explore associations between grip strength and numerous baseline variables, including testosterone use, HIV status, and demographic factors.
Among the 2575 men who participated in this study, 54% had HIV infection. Initial study age averaged 45.0 in men with HIV and 49.2 in HIV-negative men. About two thirds of men with HIV (69.6%) had an undetectable viral load at their initial MACS visit. At that visit, a significantly higher proportion of men with than without HIV used testosterone (16.5% versus 5.6%, P < 0.001).
Univariate analysis saw a significant association between testosterone use and greater grip strength, but multivariate analysis did not confirm this association (coefficient 0.39, 95% confidence interval [CI] -0.22 to 1.00, P = 0.21). Analysis not adjusted for testosterone use linked having HIV to greater grip strength in both univariate and multivariate models (coefficient 0.81, 95% CI 0.20 to 1.42, P = 0.009). But when the analysis included testosterone use, HIV was no longer independently associated with greater grip strength (coefficient 0.58, 95% CI -0.17 to 1.33, P = 0.13). That finding partly explains the impact of HIV infection on grip strength. Multivariate analysis limited to men with HIV saw no association between undetectable viral load and greater grip strength.
The MACS team concluded that, although testosterone use did not independently predict grip strength in these men with or without HIV, "it did contribute significantly to differences in grip strength noted between men with and without HIV." The investigators advised taking testosterone use into account when evaluating physical function in people with HIV. They suggested further study to clarify whether supplemental testosterone can bolster physical function in people with HIV.
Reference
1. Masters M, Yang J, Erlandson K, et al. Impact of testosterone use on grip strength in men aging with HIV. 10th International Workshop on HIV and Aging, October 10-11, 2019, New York. Abstract 3.
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