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Erectile Dysfunction and Hepatitis C Virus Infection
  RESEARCH LETTER; Journal of the American Medical Association; Asug 14, 2002; 288, p 698
To the Editor: Hepatitis C virus (HCV) infection has been associated with immune-mediated manifestations such as glomerulonephritis, thyroiditis, peripheral neuropathy, sicca syndrome, arthritis, and mixed cryoglobulinemia.Although erectile dysfunction has been anecdotally reported in patients with HCV-related chronic hepatitis, it is unclear whether this is related to superimposed liver failure, to interferon alfa treatment, or to the disease process itself.
We evaluated the prevalence of erectile dysfunction in 207 patients with HCV infection (identified by serum anti-HCV antibodies and HCV RNA), including 105 with chronic hepatitis and 102 with HCV-associated cryoglobulinemic vasculitis. Patients were consecutively recruited at liver and rheumatology clinics at a university hospital. Exclusion criteria were age older than 55 years, interferon alfa treatment in the last year, or presence of diabetes, renal failure, hypothyroidism, human immunodeficiency virus infection, or concurrent cardiovascular or psychiatric disorders. All patients gave informed consent for the study, which was approved by the local ethics committee.
All patients were asked to complete the International Index of Erectile Failure (IIEF). Those with erectile dysfunction based on this evaluation underwent nocturnal penile tumescence testing for 3 nights. We also measured serum hormone levels including total and free testosterone, follicle-stimulating hormone, luteinizing hormone, prolactin, and estradiol-17 in all patients. Finally, we compared the prevalence of erectile dysfunction in our patients with its occurrence in a sample of 207 age-matched men who were randomly selected from a larger group of 2010 Italian men previously investigated for complaints of erectile dysfunction. We performed prostate transrectal ultrasonography to exclude neoplastic disorders of the prostate and seminal vesicles in all HCV-positive patients with erectile dysfunction. Statistical analysis was performed using the 2 test with Yates correction and unpaired t test; P<.05 was considered significant.
Erectile dysfunction was diagnosed in 80 (39%) HCV-positive patients and in 29 (14%) control subjects (P<.001) on the basis of IIEF score and nocturnal penile tumescence testing. Erectile dysfunction was more common in patients with cryoglobulinemic vasculitis than in those with chronic HCV infection (44% vs 33%), although this difference was not statistically significant. Erectile dysfunction was significantly more common in both HCV groups than in control subjects (P<.001).
Plasma levels of total and free testosterone were generally lower in HCV-positive patients, but they were significantly lower in patients with erectile dysfunction vs those without. In addition, neither erectile dysfunction nor testosterone level was significantly correlated with the severity of liver involvement, as defined on the basis of ultrasound examination (ie, irregular margins of the liver, coarse echoic pattern, and hypertrophy of caudate lobus) and laboratory tests (ie, low levels of serum albumin and pseudo-cholinesterase and prolonged prothrombin time).
It has been speculated that neurovascular and hormonal effects of chronic HCV infection may contribute to the pathogenesis of erectile dysfunction. We found that hepatic failure and interferon alfa therapy were unrelated to erectile dysfunction, thus suggesting that chronic HCV infection itself may play a causal role. Nonetheless, both liver failure and interferon alfa may also contribute to erectile dysfunction, and treatment should be individualized. It is also possible, however, that antiviral treatment may improve erectile function in some HCV-positive patients, and this should be evaluated in prospective clinical trials. Finally, given the increasing prevalence of HCV,1, 7 the possibility of HCV infection should be considered in the differential diagnosis of erectile dysfunction.
Clodoveo Ferri, MD
Department of Internal Medicine, Rheumatology Unit
Maria Antonella Bertozzi
Andrology Unit
University of Pisa
Pisa, Italy
Anna Linda Zignego, MD
Department of Internal Medicine
University of Firenze
Firenze, Italy
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