In men with active hepatitis C virus (HCV) infection, elevated sex hormone-binding globulin (SHBG) may mask testosterone deficiencies, according to study results published in Clinical Infectious Diseases. The results also indicated that even after men with HCV achieved a sustained virologic response (SVR), low free testosterone (FT) levels were common.
The study included men with chronic HCV (n=327). The researchers evaluated testosterone levels and the prevalence of low testosterone. They also evaluated a subset of participants (n=85) who had recorded testosterone levels before HCV treatment and after SVR. The median follow-up time was 36 months.
The results indicated that participants with active HCV at baseline had higher total testosterone (TT) and SHBG compared with participants who had achieved SVR (both P <.0001). FT levels did not differ between the groups.
Compared with those with active HCV, participants with SVR were more likely to have low TT (<10.4 nmol/L; P =.002). Low FT (<.1735 nmol/L) was common among both participants with active HCV infection (50%) and participants with an SVR (43%), with no significant difference between groups.
In the subanalysis, the researchers found that TT and SHBG decreased significantly (P <.0001) after SVR while FT did not change. After SVR, low FT persisted (pre-treatment 58%, post-SVR 54%; P =.72).
The results indicated that HIV status and change in aspartate aminotransferase-to-platelet ratio were significant independent predictors of change in FT following SVR.
“Additional research is required to establish the mechanism responsible for hypogonadism in both patients with chronic HCV infection and in patients post-SVR and to develop strategies to optimize the recognition and management of testosterone deficiency in this setting,” the researchers wrote.
Chaudhury CS, Mee T, Chairez C, et al. Testosterone in men with chronic hepatitis C infection and after hepatitis C viral clearance. [published online February 2, 2019]. Clin Infect Dis. doi: 10.1093/cid/ciy965