Prostatic complications of testosterone replacement therapy

The prostatic complications of testosterone replacement therapy have received little clinical attention. We describe three hypogonadal men who had prostatic disease (adenocarcinoma in two) detected in relation to such therapy. Literature review suggests that surveillance for early prostate cancer is appropriate during replacement therapy in men over the age of 50 years. We discuss the selective use of digital rectal examination, transrectal sonography, directed prostate biopsy, and prostate-specific antigen determinations before therapy and in subsequent follow-up in this age group of men during androgen replacement.     

Perspectives for metabolomics in testosterone replacement therapy

Testosterone is the major circulating androgen in men but exhibits an age-related decline in the ageing male. Late-onset hypogonadism or androgen deficiency syndrome (ADS) is a 'syndromic' disorder including both a persistent low testosterone serum concentration and major clinical symptoms, including erectile dysfunction, low libido, decreased muscle mass and strength, increased body fat, decreased vitality or depressed mood. Given its unspecific symptoms, treatment goals and monitoring parameters, this review will outline the various uncertainties concerning the diagnosis, therapy and monitoring of ADS to date. Literature was identified primarily through searches for specific investigators in the PubMed database. No date or language limits were applied in the literature search for the present review. The current state of research, showing that metabolomics is starting to have an impact not only on disease diagnosis and prognosis but also on drug treatment efficacy and safety monitoring, will be presented, and the application of metabolomics to improve the clinical management of ADS will be discussed. Finally, the scientific opportunities presented by metabolomics and other -omics as novel and promising tools for biomarker discovery and individualised testosterone replacement therapy in men will be explored.     

Complications of HIV disease and therapy

Complications and consequences of untreated and treated HIV infection in domestic and international settings continue to be a major focus of HIV clinical research efforts. In this review major findings in these areas are highlighted, with a focus on studies that have application to clinical practice. As the field of clinical research in HIV continues to mature, we are repeatedly surprised by the findings from well-designed studies.     

Adherence to HIV antiretroviral therapy in HIV+ Ugandan patients purchasing therapy

Our objective was to determine the level of adherence and reasons for non-adherence to antiretroviral therapy (ART) among HIV-positive (HIV+) people on ART in a resource-limited setting. Patients receiving ART were recruited into the cross-sectional study from three treatment centres in Kampala, Uganda. The number of missed doses over the last three days was assessed by structured patient interviews and dichotomized at +/-95% adherence. Reasons for non-adherence were assessed with both structured patient interviews and unstructured qualitative interviews. Independent predictors of non-adherence were assessed with multivariate logistic regression. In all, 304 HIV-infected persons on ART were enrolled into the study. Factors associated with non-adherence were marital status (odds ratio (OR) = 2.93, 95% confidence interval (CI) 1.32-6.50) and low monthly income <50 US$ [OR = 2.77, 95% CI 1.64-4.67]. We concluded that levels of self-reported adherence in patients receiving ART in Kampala are comparable to levels in resource-rich settings with inability to purchase and secure a stable supply as a major barrier to adherence.     

Anemia and HIV in the antiretroviral era: potential significance of testosterone

Anemia, the most common hematological disorder in human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS), is associated with decreased quality of life and survival. Hypogonadism is prevalent in advanced HIV disease, however, low testosterone levels have not been customarily implicated in HIV-associated anemia. This study was undertaken to determine whether there is a relationship between testosterone levels and androgen use with anemia in HIV, and to characterize other clinical correlates of HIV-associated anemia. This was a cross-sectional, observational study of 200 HIV-positive patients at a public hospital HIV clinic from July 2000 to August 2001. A written questionnaire detailed previous and current medication use, opportunistic infections, and malignancies. Hematological and virological parameters, testosterone, and erythropoietin levels were measured; CD4(+) T lymphocyte count and viral load nadir and peak levels were obtained from the computerized medical record. Anemia was defined as hemoglobin <13.5 g/dl in men and <11.6 g/dl in women. Twenty-four percent of women and 28% of men were anemic. Anemia was associated with lymphopenia (adjusted OR 4.0, 95% CI 1.36-11.80), high erythropoietin levels (adjusted OR 7.73, 95% CI 2.92-20.48), and low testosterone levels (adjusted OR 3.27, 95% CI 1.01-10.60). Anemia was negatively associated with female sex (adjusted OR 0.30, 95% CI 0.11-0.85), current antiretroviral therapy (adjusted OR 0.43, 95% CI 0.20-0.95), current androgen use (adjusted OR 0.20, 95% CI 0.05-0.84), and macrocytosis (adjusted OR 0.23, 95% CI 0.09-0.61). Low testosterone levels may have a positive association and supplemental androgens a negative association with anemia in HIV disease.     

Heart failure therapy: testosterone replacement and its implications.

Heart failure: therapeutic targets Chronic heart failure (CHF) is a serious health care problem,associated with a high hospitalization rate and poor prognosis.CHF treatment means modern combination therapy, nevertheless,its associated mortality is higher than that of most cancers.Patients with CHF also have a poor quality-of-life. The majority of today's therapeutic knowledge is based on evidencefrom large-scale multi-centre, double-blind, placebo-controlledintervention trials. During the last 20 years, a remarkableevolution of therapeutic concepts has taken place with ACE-inhibitors,beta-blockers, and aldosterone receptor antagonists markingmilestones of CHF therapy.¹ The therapeutic targets in patientswith CHF are two-fold: first, an increase of life expectancy,and, secondly, improvements in quality-of-life. First, prolongation of lifespan can be reached if the progressionof the disease can be stopped, delayed, reversed, or if therisk for sudden cardiac death     

Complications of HIV disease and antiretroviral therapy

As antiretroviral treatment regimens become more potent and easier to administer, differences in the rates of adverse events and complications associated with treatment will increasingly drive decisions regarding the selection of therapy. This year's Conference on Retroviruses and Opportunistic Infections featured a wide range of research directed toward understanding the pathogenesis, treatment, and long-term consequences of complications associated with HIV infection and the use of antiretroviral therapy in both resource-limited settings and in the developed world. This review will summarize information on complications of antiretroviral therapy in resource-limited settings, hepatitis C virus, tuberculosis, and discussion of metabolic, cardiovascular, and renal complications.     

Combination antiretroviral therapy failure and HIV super-infection

In addition to development or selection of resistance, failure to continuously suppress HIV-1 production while still using initially effective combination antiretroviral therapy (cART) may result from super-infection with a drug-resistant strain. Both transmission of drug resistant HIV and super-infection have been demonstrated. We analysed HIV pol genes obtained before start of initially successful cART and during failure while still on cART in 101 patients. Difference in precART and cART failure sequences were explained by evolution and not by super-infection.