Here, we aimed to determine the prevalence of erectile dysfunction (ED) among HIV-infected men and its association with components of antiretroviral therapy.
Methods
Cross-sectional data on sexual dysfunction were collected in the Swiss HIV Cohort Study (SHCS) between December 2009 and November 2010. Multilevel logistic regression models were used to estimate the association between ED and exposure to 24 different antiretroviral drugs from four drug classes.
Results
During the study period, 5,194 of 5,539 eligible men in the SHCS had a follow-up visit; 4,064 men answered a question on ED for the first time. Among these men, ED was experienced often by 459 (11%), sometimes by 543 (13%), rarely by 389 (10%), never by 2,526 (62%) and 147 (4%) did not know. ED was associated with older age, an earlier HIV diagnosis and depression. No association was found with any drug class; however, ED was associated with cumulative exposure to either zalcitabine (OR 1.29 per year of use; 95% CI 1.07, 1.55) or enfuvirtide (OR 1.28; 95% CI 1.08, 1.52).
Conclusions
Around 1 in 10 men in the SHCS reported often experiencing ED. We found no association between ED and any drug class, but those exposed to zalcitabine or enfurvitide (drugs no longer or rarely used) were more likely to report ED; this second association was probably not causal.
References
1.
CrumN.F., FurtekK.J., OlsonP.E., AmlingC.L., WallaceM.R.A review of hypogonadism and erectile dysfunction among HIV-infected men during the pre- and post-HAART eras: diagnosis, pathogenesis, and management. AIDS Patient Care STDS2005; 19: 655–671.
2.
JonesM., KlimesI., CatalanJ.Psychosexual problems in people with HIV infection: controlled study of gay men and men with haemophilia. AIDS Care1994; 6: 587–593.
3.
SchrootenW., ColebundersR., YouleM.Sexual dysfunction associated with protease inhibitor containing highly active antiretroviral treatment. AIDS2001; 15: 1019–1023.
4.
SollimaS., OsioM., MusciaF.Protease inhibitors and erectile dysfunction. AIDS2001; 15: 2331–2333.
5.
CollazosJ., MartinezE., MayoJ., IbarraS.Sexual dysfunction in HIV-infected patients treated with highly active antiretroviral therapy. J Acquir Immune Defic Syndr2002; 31: 322–326.
6.
ColsonA.E., KellerM.J., SaxP.E., PettusP.T., PlattR., ChooP.W.Male sexual dysfunction associated with antiretroviral therapy. J Acquir Immune Defic Syndr2002; 30: 27–32.
7.
LallemandF., SalhiY., LinardF., GiamiA., RozenbaumW.Sexual dysfunction in 156 ambulatory HIV-infected men receiving highly active antiretroviral therapy combinations with and without protease inhibitors. J Acquir Immune Defic Syndr2002; 30: 187–190.
8.
LambaH., GoldmeierD., MackieN.E., ScullardG.Antiretroviral therapy is associated with sexual dysfunction and with increased serum oestradiol levels in men. Int J STD AIDS2004; 15: 234–237.
9.
EndeA.R., LoR.V.III, DiNubileM.J., MounzerK.Erectile dysfunction in an urban HIV-positive population. AIDS Patient Care STDS2006; 20: 75–78.
10.
AsboeD., CatalanJ., MandaliaS.Sexual dysfunction in HIV-positive men is multi-factorial: a study of prevalence and associated factors. AIDS Care2007; 19: 955–965.
11.
Crum-CianfloneN.F., BavaroM., HaleB.Erectile dysfunction and hypogonadism among men with HIV. AIDS Patient Care STDS2007; 21: 9–19.
12.
Moreno-PérezO., EscoínC., Serna-CandelC.Risk factors for sexual and erectile dysfunction in HIV-infected men: the role of protease inhibitors. AIDS2010; 24: 255–264.
13.
NIH Consensus Conference.Impotence. NIH Consensus Development Panel on Impotence. JAMA1993; 270: 83–90.
14.
ChengJ.Y., NgE.M.Body mass index, physical activity and erectile dysfunction: an U-shaped relationship from population-based study. Int J Obes (Lond)2007; 31: 1571–1578.
15.
NewshanG., TaylorB., GoldR.Sexual functioning in ambulatory men with HIV/AIDS. Int J STD AIDS1998; 9: 672–676.
16.
WunderD.M., BersingerN.A., FuxC.A.Hypogonadism in HIV-1-infected men is common and does not resolve during antiretroviral therapy. Antivir Ther2007; 12: 261–265.
GuaraldiG., LuziK., MurriR.Sexual dysfunction in HIV-infected men: role of antiretroviral therapy, hypogonadism and lipodystrophy. Antivir Ther2007; 12: 1059–1065.
19.
CollazosJ.Sexual dysfunction in the highly active antiretroviral therapy era. AIDS Rev2007; 9: 237–245.
20.
YoungJ., GlassT.R., BernasconiE.Hierarchical modeling gave plausible estimates of associations between metabolic syndrome and components of antiretroviral therapy. J Clin Epidemiol2009; 62: 632–641.
21.
Schoeni-AffolterF., LedergerberB., RickenbachM.Cohort profile: the Swiss HIV Cohort study. Int J Epidemiol2010; 39: 1179–1189.
22.
RosenR.C., RileyA., WagnerG., OsterlohI.H., KirkpatrickJ., MishraA.The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology1997; 49: 822–830.
23.
CappelleriJ.C., RosenR.C., SmithM.D., MishraA., OsterlohI.H.Diagnostic evaluation of the erectile function domain of the International Index of Erectile Function. Urology1999; 54: 346–351.
24.
GreenlandS.When should epidemiologic regressions use random coefficients?Biometrics2000; 56: 915–921.
25.
GreenlandS.Methods for epidemiologic analyses of multiple exposures: a review and comparative study of maximum-likelihood, preliminary-testing, and empirical-Bayes regression. Stat Med1993; 12: 717–736.
26.
WitteJ.S., GreenlandS., KimL.L., ArabL.Multilevel modeling in epidemiology with GLIMMIX. Epidemiology2000; 11: 684–688.
27.
HernánM.A., Hernández-DíazS., WerlerM.M., MitchellA.A.Causal knowledge as a prerequisite for confounding evaluation: an application to birth defects epidemiology. Am J Epidemiol2002; 155: 176–184.
28.
ConenA., FehrJ., GlassT.R.Self-reported alcohol consumption and its association with adherence and outcome of antiretroviral therapy in the Swiss HIV Cohort Study. Antivir Ther2009; 14: 349–357.
GreenlandS.Dose-response and trend analysis in epidemiology: alternatives to categorical analysis. Epidemiology1995; 6: 356–365.
31.
TrottaM.P., AmmassariA., Cozzi-LepriA.Adherence to highly active antiretroviral therapy is better in patients receiving non-nucleoside reverse transcriptase inhibitor-containing regimens than in those receiving protease inhibitor-containing regimens. AIDS2003; 17: 1099–1102.
32.
BlumA.S., Dal PanG.J., FeinbergJ.Low-dose zalcitabine-related toxic neuropathy: frequency, natural history, and risk factors. Neurology1996; 46: 999–1003.
33.
Arenas-PintoA., BhaskaranK., DunnD., WellerI.V.The risk of developing peripheral neuropathy induced by nucleoside reverse transcriptase inhibitors decreases over time: evidence from the Delta trial. Antivir Ther2008; 13: 289–295.
34.
RichardsonD., LambaH., GoldmeierD., NalabandaA., HarrisJ.R.Factors associated with sexual dysfunction in men with HIV infection. Int J STD AIDS2006; 17: 764–767.
35.
ScherrerA.U., von WylV., FuxC.A.Implementation of raltegravir in routine clinical practice: selection criteria for choosing this drug, virologic response rates, and characteristics of failures. J Acquir Immune Defic Syndr2010; 53: 464–471.
36.
YoungJ., WeberR., RickenbachM.Lipid profiles for antiretroviral-naive patients starting PI- and NNRTI-based therapy in the Swiss HIV cohort study. Antivir Ther2005; 10: 585–591.
37.
RossA.C., RizkN., O'RiordanM.A.Relationship between inflammatory markers, endothelial activation markers, and carotid intima-media thickness in HIV-infected patients receiving antiretroviral therapy. Clin Infect Dis2009; 49: 1119–1127.
