title: Erectile dysfunction, testosterone deficiency, and risk of coronary heart disease in a cohort of men living with HIV in Belgium.
abstract: BACKGROUND
  Erectile dysfunction (ED) is more prevalent in men living with HIV (MLHIV) when compared with age-matched HIV-negative men. This may be related to a premature decline in testosterone levels. In the general population, ED has been associated with an increased risk for coronary heart disease (CHD).
  
  
  OBJECTIVE
  The aim of this study is to determine the prevalence of ED, testosterone deficiency, and risk of CHD in a cohort of young to middle-aged MLHIV in Belgium.
  
  
  METHODS
  A cross-sectional, observational study among 244 MLHIV attending the outpatient clinic of the Institute of Tropical Medicine in Antwerp.
  
  
  METHODS
  The short version of the international index of erectile function (IIEF-5) questionnaire diagnosed ED (cutoff score ≤ 21). The 10-year risk score for CHD was calculated. In a subset of men reporting ED, the calculated free testosterone (CFT) was determined using Vermeulen's formula. Testosterone deficiency was defined as CFT <0.22 nmol/L.
  
  
  RESULTS
  One hundred fifty-one men (61.9%) self-reported ED (median IIEF-5 score: 16 [interquartile range (IQR) 12-19]). In multivariate analysis, only increasing age, but none of the HIV-related parameters, nor any of the individual cardiovascular-risk related parameters, was statistically significantly associated with ED. Eighteen out of the 49 (36.7%) men with ED who received a blood test to assess testosterone levels were diagnosed with testosterone deficiency. The 10-year risk of CHD in the cohort was 4.3% (IQR 3.6-5.7) and was significantly higher in men with ED (5.1%, IQR 4.4-6.6) compared with men without ED (3.1%, IQR 2.5-4.2).
  
  
  CONCLUSIONS
  This study showed that ED and testosterone deficiency are highly prevalent in young to middle-aged MLHIV and that ED might be associated with an increased risk of CHD. Therefore, healthcare professionals should screen for clinical ED and should consider testing for underlying testosterone deficiency. A clinical diagnosis of ED should trigger a full evaluation of the patient's cardiovascular risk factors, even at younger age.
authors: Department of Clinical Sciences, Institute of Tropical Medicine (ITM), Antwerp, Belgium. irisderyck@hotmail.com
authors: Iris
authors: I
authors: De Ryck
authors: David
authors: D
authors: Van Laeken
authors: Ludwig
authors: L
authors: Apers
authors: Robert
authors: R
authors: Colebunders
mesh_terms: D000328:Adult; D001530:Belgium / Q000453:epidemiology; D003324:Coronary Artery Disease / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D007172:Erectile Dysfunction / Q000097:blood / Q000453:epidemiology*; D015658:HIV Infections / Q000453:epidemiology*; D006679:HIV Seropositivity / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D013739:Testosterone / Q000097:blood / Q000172:deficiency*
chemical_list: D013739:Testosterone
keywords: Coronary Heart Disease (CHD); Erectile Dysfunction (ED); Hypogonadism; MLHIV; Testosterone Deficiency; Vascular Risk Factor