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  IAS 2017: Conference on HIV Pathogenesis
Treatment and Prevention
Paris, France
July 23-26 2017
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HIV Linked to Decreased Erectile Function in
MSM 45 or Older - comorbidities, depression, frailty

  9th IAS Conference on HIV Science (IAS 2017), July 23-26, 2017, Paris
Mark Mascolini
HIV infection independently predicted decreased erectile function in a Netherlands comparison of men with or without HIV and 45 or older [1]. Current lopinavir/ritonavir also boosted odds of decreased erectile function in this AGEhIV cohort analysis of men who have sex with men (MSM).
Previous research found decreased sexual function in HIV-positive people compared with the general population. AGEhIV investigators analyzed MSM in their cohort to determine (1) whether HIV independently predicts decreased sexual function and (2) risk factors for decreased sexual function in men with HIV.
AGEhIV recruits HIV-positive men and women 45 years old or older and a similar group of HIV-negative people the same age. The sexual function analysis focused on 399 HIV-positive MSM and 366 HIV-negative MSM. Participants completed a standardized 3-item questionnaire, the International Index of Erectile Function. They also answered questions about satisfaction with their sex life and worries about minimal sexual desire.
The HIV-positive and negative groups had median ages of 53.6 and 52.3 years. Almost all HIV-positive men (95%) were taking antiretroviral therapy, and 97% had an undetectable viral load. Significantly more HIV-positive men had decreased sexual satisfaction (about 18% versus 12%, P = 0.02), decreased desire (about 7% versus 4%, P = 0.03), and decreased erectile function (about 13% versus 4%, P < 0.001).
Multivariable logistic regression adjusted for age and ethnicity linked HIV infection to decreased erectile function (adjusted odds ratio [aOR] 4.1). In the same analysis HIV infection almost doubled the odds of decreased sexual desire (aOR 1.9) but the 95% confidence interval (CI) for this association crossed 1.0. A second model adjusted for age, ethnicity, waist-to-hip ratio, number of age-related comorbidities, depression, frailty, and use of antidepressants or antihypertensives. In this analysis HIV infection remained independently associated with decreased erectile function (aOR 2.5) but not with decreased desire or decreased satisfaction.
A multivariable model considering only HIV-positive MSM adjusted for frailty and number of age-related comorbidities. This model found a borderline significant association between time spent with a CD4 count below 200 and decreased erectile function (aOR 1.2 per year, 95% CI 0.9 to 1.4). This analysis found no association between years of HIV infection, CD4 nadir, duration of viral undetectability, viral load, years taking antiretrovirals, or a prior AIDS diagnosis and erectile dysfunction.
Another adjusted analysis saw a trend toward prior lopinavir/ritonavir use and decreased erectile function. Current exposure to lopinavir/ritonavir independently boosted odds of erectile dysfunction in three multivariable models, with adjusted odds ratios ranging from 4.3 to 5.6. Neither atazanavir nor darunavir predicted decreased erectile function in this analysis.
The AGEhIV team concluded that HIV infection is independently associated with decreased erectile function in MSM 45 year old or older. They proposed that higher prevalence of decreased sexual satisfaction in middle-aged to older men with HIV "may be explained by higher prevalence of depression, frailty, and age-related comorbidities."
1. Dijkstra M, van Lunsen RHW, Kooij KW, et al. HIV-1 infection and sexual functioning among middle-aged men who have sex with men. 9th IAS Conference on HIV Science (IAS 2017), July 23-26, 2017, Paris. Abstract WEAB0104.