Sexual dysfunction associated with protease inhibitor containing HAART

Schrooten and colleagues reported in AIDS (Vol15 No8) the results of an anonymous survey of 904 individuals from a study conducted across 10 European countries between December 1998 and December 1999.

The results showed that 40% (308/766) of both men and women on a protease inhibitor containing regimen reported a decrease in sexual interest compared to 16% (22/138) of protease na¥ve patients. The results also showed a large number of protease experienced men in this group, 34% (216/628), reported a decrease in sexual potency compared with 12% (12/99) of protease na¥ve men.

Other significant factors in this study for decrease in sexual interest were current protease containing regimens, previous exposure to protease containing regimens, symptomatic HIV, homosexual sex as mode of transmission and age. The factors associated with a decrease in sexual potency included current protease containing regimens, symptomatic HIV, age and use of tranquillisers. Although both decreases in sexual interest and sexual potency were shown as more prevalent in ritonavir and indinavir containing regimens than nelfinavir the mean duration in months for nelfinavir regimens was lower. Reports of sexual dysfunction in protease experienced individuals were also more common where the person had signs of lipodystrophy or peripheral neuropathy.

Reference: Schrooten W, Colebunders R, Youle M et al and the Eurosupport Study Group. Sexual dysfunction associated with protease inhibitor containing highly active antiretroviral treatment. AIDS 2001, 15:1019-1023.

Comment

This report shows that the number of people affected by sexual dysfunction is potentially higher than previously thought and is probably under-reported in clinical practice for a variety of reasons. Sexual dysfunction itself is somewhat complex and can have several contributing factors outside of HIV, including psychological, hormonal and side effects of medications.

This study did not collect psychological data and so was not able to look at the contribution of depression to sexual dysfunction in this group nor the relationship of body image and sexual dysfunction. However the authors themselves suggest that further research is needed to establish pathophysiological mechanisms of sexual dysfunction for those individuals on HAART and how best to manage and treat it.