common in HIV-infected women.

common in HIV-infected women. Dolan Looby and colleagues investigated the long-term effects of transdermal testosterone on body composition, bone mineral density, quality of life, and safety. Twenty-five HIV-infected women with free testosterone below the median (Women demonstrated low androgen levels (1.3 +/- 0.1 pg/ml) with relatively low weight (22.8 +/- 0.6 kg/m) and low bone mineral density (-0.61 +/- 0.17 SD hip T score) at baseline. No statistically significant differences were seen between the groups at baseline. The discontinuation rate was 16% and did not differ between treatment groups (P = 0.24). Free testosterone by equilibrium dialysis increased over 18 months (7.9 +/- 1.8 vs. 0.3 +/- 0.4 pg/ml; P = 0.002, testosterone vs. placebo). Testosterone was well tolerated and did not affect lipids, liver, or safety indices. Lean mass (1.8 +/- 0.5 vs. 0.8 +/- 0.9 kg; P = 0.04) and BMI (1.6 +/- 0.4 vs. 0.8 +/- 0.6 kg/m; P = 0.03, testosterone vs. placebo) increased in response to testosterone, whereas fat mass remained unchanged. Testosterone increased bone mineral density at the hip (0.01 +/- 0.01 vs. -0.01 +/- 0.01 g/cm; P = 0.02) and trochanter (0.01 +/- 0.01 vs. -0.02 +/- 0.01 g/cm; P = 0.01, testosterone vs. placebo). Testosterone significantly improved depression indices (-6.8 +/- 2.2 vs. -1.9 +/-3.1; P = 0.02) and problems affecting sexual function (-1.8 +/- 0.8 vs. 0.5 +/-0.5; P = 0.01, testosterone vs. placebo). Long-term testosterone administration was well tolerated in HIV-infected women and resulted in significant improvements in body composition, bone mineral density, and quality of life indices. Further evaluation of the safety and efficacy of testosterone use among HIV-infected women is warranted.

Androgen deficiency is highly prevalent among women living with HIV and is associated with reduced lean body mass, bone mineral density, and quality of life. Whereas treatment is routine in HIV-positive men with low testosterone levels, no treatment strategies exist for women with similar problems. This is the first long-term (18 months) randomised controlled trial in HIV-positive women of the effects of testosterone administered via a transdermal patch versus a control patch. Because it reveals very encouraging effects on bone mineral density, body composition, and quality of life without signs of virilisation, further studies of long-term treatment with testosterone for women living with HIV should proceed to see if these encouraging findings are confirmed.