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Risk Factors for Sexual Dysfunction in Men with HIV

SUMMARY: More than half of HIV positive men may experience erectile dysfunction and reduced sexual satisfaction, according to a study published in the January 2010 issue of AIDS. As expected, older age was a risk factor, as was longer duration of protease inhibitor use.

By Liz Highleyman

O. Moreno-Perez from Hospital General Universitario de Alicante in Spain and colleagues conducted a study to assess the prevalence of erectile dysfunction in men with stable HIV disease. They also looked at the effects of antiretroviral drug exposure and other potential risk factors.

This cross-sectional, observational study included 90 HIV positive men without hepatitis C coinfection; the average age was 42 years. Most participants (84%) were taking combination antiretroviral therapy (ART) and 43% were using a protease inhibitor; the NNRTI group had never been exposed to protease inhibitors.

Participants overall had relatively well-controlled disease; 72.2% had undetectable HIV viral load and the average CD4 cell count was 465 cells/mm3, but 19% had AIDS (CDC class C disease). About one-third (32%) had lipodystrophy.

Sexual dysfunction was assessed using a questionnaire about sexual satisfaction. Erectile dysfunction was defined as an ejection fraction of 25 or less (International Index of Erectile Function-15).


One-third of the men (31%) reported "impotence," and most said this had worsened over time.
Based on a standardized questionnaire, 53% experienced mild to severe erectile dysfunction.
In a multivariate analysis, the following factors were independently associated with greater likelihood of erectile dysfunction:
Older age (odds ration 2.2 per decade; P = 0.04);
Longer duration of protease inhibitor exposure (odds ratio 1.6 per year; P = 0.01).
Men with erectile dysfunction had take protease inhibitors for 6 years on average, compared with 3 years for men without erectile problems.
All men with low measured testosterone levels reported erectile dysfunction.
Older age, depression, and lipodystrophy, combined with duration of protease inhibitor exposure, predicted a lower (worse) score on various sexual dysfunction domains (P < 0.05).
12% of participants used erectile dysfunction drugs (e.g., sildenafil [Viagra]), with most (80%) reporting that they were effective.

Based on these findings, the study authors concluded, "There is a high prevalence of erectile dysfunction in HIV-infected men, with age and the duration of exposure to protease inhibitor being the only identifiable risk factors."

Department of Endocrinology and Nutrition, Hospital General Universitario de Alicante, Alicante, Spain.


O Moreno-Perez, C Escoin, C Serna-Candel, and others. Risk factors for sexual and erectile dysfunction in HIV-infected men: the role of protease inhibitors. AIDS 24(2): 255-264 (Abstract). January 2010.
















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