Erectile Dysfunction in Men with Human Immunodeficiency Virus: Prevalence and Associated Factors

Overview

Journal Transl Androl Urol

Date 2024 Dec 19

PMID 39698577

Authors

Suzane Skura

Anna Martha Vaitses Fontanari

Lia Beatriz Henke de Azevedo

Raquel Maieli Bagatini

Valdir Spada Junior

Dalila Moter Benvegnu

Paulo Cezar Nunes Fortes

Angelo Brandelli Costa

Guilherme Welter Wendt

Lirane Elize Defante Ferreto

Affiliations

Soon will be listed here.

Abstract

Background: Male sexuality plays a crucial role in determining the overall quality of life, and it involves complex interactions between physical systems and psychosocial dimensions. Erectile dysfunction (ED) has a particularly notable impact on men's well-being, especially among those living with human immunodeficiency virus (HIV). This study's aim was to explore the prevalence of ED and its associated factors in men with HIV.

Methods: Cross-sectional research was conducted in a specialized care unit in Paraná, involving 120 adult men living with HIV. Data collection occurred from March 2021 to December 2023, and ED was assessed using the 6-item version of International Index of Erectile Function (IIEF-6) questionnaire. Psychological factors were assessed using the Depression, Anxiety and Stress Scales-21 (DASS-21). The primary outcome was ED.

Results: The prevalence of ED was 37.5% [95% confidence interval (CI): 28.8% to 46.2%]. A significant association was observed between advanced age and ED. Regarding the type of antiretroviral therapy (ART), the data revealed a significant association with ED, the differences were particularly notable when comparing the therapeutic regimens of nucleoside reverse transcriptase inhibitor (NRTI) + Integrase inhibitor (INI) . NRTI + protease inhibitor (PI) and NRTI + NRTI. Furthermore, mental health factors were analyzed, with anxiety demonstrating a significant association with ED [odds ratio (OR) =2.35; 95% CI: 1.02 to 5.43; P=0.046].

Conclusions: The findings highlight the urgent need for an integrated approach to clinical management that considers both medical and emotional aspects in men living with HIV. It has also a potential to subside further investigations, particularly those adopting a longitudinal design to capture casual mechanisms of ED in men with HIV.

References

Erens B, Mitchell K, Gibson L, Datta J, Lewis R, Field N . Health status, sexual activity and satisfaction among older people in Britain: A mixed methods study. PLoS One. 2019; 14(3):e0213835. PMC: 6436725. DOI: 10.1371/journal.pone.0213835. View

Saramies J, Koiranen M, Auvinen J, Uusitalo H, Hussi E, Becker S . A Natural History of Erectile Dysfunction in Elderly Men: A Population-Based, Twelve-Year Prospective Study. J Clin Med. 2022; 11(8). PMC: 9029758. DOI: 10.3390/jcm11082146. View

Fumaz C, Ayestaran A, Perez-Alvarez N, Munoz-Moreno J, Ferrer M, Negredo E . Clinical and Emotional Factors Related to Erectile Dysfunction in HIV-Infected Men. Am J Mens Health. 2016; 11(3):647-653. PMC: 5675217. DOI: 10.1177/1557988316669041. View

Asboe D, Catalan J, Mandalia S, Dedes N, Florence E, Schrooten W . Sexual dysfunction in HIV-positive men is multi-factorial: a study of prevalence and associated factors. AIDS Care. 2007; 19(8):955-65. DOI: 10.1080/09540120701209847. View

Schrooten W, Colebunders R, Youle M, Molenberghs G, Dedes N, Koitz G . Sexual dysfunction associated with protease inhibitor containing highly active antiretroviral treatment. AIDS. 2001; 15(8):1019-23. DOI: 10.1097/00002030-200105250-00010. View

Jansen N, Daniels C, Sunil T, Xu X, Cota J, Ganesan A . Factors associated with erectile dysfunction diagnosis in men with HIV infection: a case-control study. HIV Med. 2021; 22(7):617-622. DOI: 10.1111/hiv.13107. View

Parent M, Wille L . Heterosexual Self-Presentation, Identity Management, and Sexual Functioning Among Men Who Have Sex with Men. Arch Sex Behav. 2021; 50(7):3155-3162. PMC: 10372788. DOI: 10.1007/s10508-021-01968-z. View

Moreno-Perez O, Escoin C, Serna-Candel C, Pico A, Alfayate R, Merino E . Risk factors for sexual and erectile dysfunction in HIV-infected men: the role of protease inhibitors. AIDS. 2009; 24(2):255-64. DOI: 10.1097/QAD.0b013e328334444b. View

De Vincentis S, Decaroli M, Milic J, Fanelli F, Tartaro G, Diazzi C . Determinants of sexual function in men living with HIV younger than 50 years old: Focus on organic, relational, and psychological issues. Andrology. 2022; 11(6):954-969. DOI: 10.1111/andr.13372. View

10.

Phillips A, Venter F, Havlir D, Pozniak A, Kuritzkes D, Wensing A . Risks and benefits of dolutegravir-based antiretroviral drug regimens in sub-Saharan Africa: a modelling study. Lancet HIV. 2018; 6(2):e116-e127. PMC: 6361866. DOI: 10.1016/S2352-3018(18)30317-5. View

11.

Rosen R, Cappelleri J, Smith M, Lipsky J, Pena B . Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 2000; 11(6):319-26. DOI: 10.1038/sj.ijir.3900472. View

12.

Ma K, Song P, Liu Z, Yang L, Wang L, Zhou J . Genetic evidence suggests that depression increases the risk of erectile dysfunction: A Mendelian randomization study. Front Genet. 2022; 13:1026227. PMC: 9614163. DOI: 10.3389/fgene.2022.1026227. View

13.

Vignola R, Tucci A . Adaptation and validation of the depression, anxiety and stress scale (DASS) to Brazilian Portuguese. J Affect Disord. 2013; 155:104-9. DOI: 10.1016/j.jad.2013.10.031. View

14.

Quilter M, Hodges L, von Hurst P, Borman B, Coad J . Male Sexual Function in New Zealand: A Population-Based Cross-Sectional Survey of the Prevalence of Erectile Dysfunction in Men Aged 40-70 Years. J Sex Med. 2017; 14(7):928-936. DOI: 10.1016/j.jsxm.2017.05.011. View

15.

Incera-Fernandez D, Roman F, Gamez-Guadix M . Risky Sexual Practices, Sexually Transmitted Infections, Motivations, and Mental Health among Heterosexual Women and Men Who Practice Sexualized Drug Use in Spain. Int J Environ Res Public Health. 2022; 19(11). PMC: 9180103. DOI: 10.3390/ijerph19116387. View

16.

Lovibond P, LOVIBOND S . The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995; 33(3):335-43. DOI: 10.1016/0005-7967(94)00075-u. View

17.

Chirca N, Streinu-Cercel A, Stefan M, Aurelian J, Persu C . A Novel Risk Calculator to Predict Erectile Dysfunction in HIV-Positive Men. J Pers Med. 2023; 13(4). PMC: 10140986. DOI: 10.3390/jpm13040679. View

18.

Salonia A, Bettocchi C, Boeri L, Capogrosso P, Carvalho J, Cilesiz N . European Association of Urology Guidelines on Sexual and Reproductive Health-2021 Update: Male Sexual Dysfunction. Eur Urol. 2021; 80(3):333-357. DOI: 10.1016/j.eururo.2021.06.007. View

19.

Goldstein I, Goren A, Li V, Tang W, Hassan T . Epidemiology Update of Erectile Dysfunction in Eight Countries with High Burden. Sex Med Rev. 2019; 8(1):48-58. DOI: 10.1016/j.sxmr.2019.06.008. View

20.

Santi D, Brigante G, Zona S, Guaraldi G, Rochira V . Male sexual dysfunction and HIV--a clinical perspective. Nat Rev Urol. 2014; 11(2):99-109. DOI: 10.1038/nrurol.2013.314. View