Risk factors for sexual and erectile dysfunction in HIV-infected men: the role of protease inhibitors.
OBJECTIVE
To determine the prevalence of erectile dysfunction in a cohort of HIV-infected men in a stable clinical state, the effect of exposure to antiretroviral therapy on sexual dysfunction and to identify the risk factors.


METHODS
This is a cross-sectional, observational study.


METHODS
HIV-infected men without hepatitis C virus coinfection were included if they were antiretroviral therapy-naive (naive group), on current treatment with an enhanced protease inhibitor (protease inhibitor group) or on current treatment with two to three nucleoside reverse transcriptase inhibitors along with one nonnucleoside reverse transcriptase inhibitor and never having received treatment with protease inhibitor (nonnucleoside reverse transcriptase inhibitor group). Erectile dysfunction was defined as an ejection fraction of 25 or less (International Index of Erectile Function-15).


RESULTS
Ninety patients were included, with an age of 42 +/- 8.2 years and CD4 cell count of 465 cells/microl [P25-75 361-676]: 18.9% in Centers for Disease Control and Prevention class C and 72.2% with undetectable viral load. Seventy-six patients (84.4%) were receiving antiretroviral therapy, 39 (43.3%) in the protease inhibitor group. The prevalence of lipodystrophy was 31.5%. Forty-seven (53.4%) patients had an erectile dysfunction. Multivariate logistic regression analysis confirmed that there was an independent association between the patients' age (per decade; odds ratio 2.2, 95% confidence interval 1.04-4.5, P = 0.04) and greater duration of exposure to protease inhibitor (per year; odds ratio 1.6, 95% confidence interval 1.12-2.4, P = 0.01). Older age, depression and lipodystrophy, combined with the duration of exposure to protease inhibitor, determined a lower score on various sexual dysfunction domains (P < 0.05).


CONCLUSIONS
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.
Moreno-Pérez
Oscar
O
Department of Endocrinology and Nutrition, Hospital General Universitario de Alicante, Alicante, Spain. moreno_osc@gva.es
Escoín
Corina
C
Serna-Candel
Carmen
C
Picó
Antonio
A
Alfayate
Rocio
R
Merino
Esperanza
E
Reus
Sergio
S
Boix
Vicente
V
Sanchez-Paya
José
J
Portilla
Joaquin
J
D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D007172:Erectile Dysfunction / Q000139:chemically induced / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D015497:HIV-1; D039682:HIV-Associated Lipodystrophy Syndrome / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D012735:Sexual Dysfunction, Physiological / Q000139:chemically induced* / Q000453:epidemiology / Q000523:psychology; D019562:Viral Load
D017320:HIV Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors