Study finds sexual dysfunction common in HIV-positive men receiving HAART but unrelated to protease inhibitors

Sexual dysfunction in HIV patients has rarely been studied; sexual function has mostly been studied in this population with respect to HIV transmission.

Before the era of highly active antiretroviral therapy (HAART), it was thought that people living with HIV/AIDS had little interest in sexual relations because of the frequency of opportunistic infections and altered general health status. HAART has led to vast health improvement in people living with HIV/AIDS, enabling them to envision their life in the future.

“Clearly, the diagnosis and treatment of sexual dysfunction in these patients deserve the same attention as those in the rest of the population.

Earlier identification and treatment of sexual dysfunction should improve mood, quality of life, and therefore, adherence to treatment,” the authors wrote. They conducted a cross-sectional study of 156 ambulatory HIV-infected homosexual or bisexual men to assess and compare the prevalence and characteristics of sexual dysfunction according to the antiretroviral drug combinations they were receiving. Group A included patients who had been receiving an ongoing PI-containing HAART regimen for more than one month.

Group B included patients who had never received PI treatment. Group C included patients who had stopped taking PI therapy more than one month previously.

One hundred and fifty-six patients completed the study. The median age of the patients was 40.5 7.7 years, and the median CD4+ cell count was 415

236/mm3. Of the patients, 111 reported some degree of sexual dysfunction since the beginning of their ongoing treatment (65 of 91 group A patients; 15 of 23 group B patients, and 31 of 42 group C patients), with no significant difference among the three groups. Of 111 patients, 99 (89%) reported a reduction or loss of libido, 96 (86%) reported erectile dysfunction, 76 (68%) reported orgasmic disorders, and 65 (59% ) reported ejaculatory disorders. There was no significant difference among the three groups. A history of sexual dysfunction was reported by 18% of patients before HIV seropositivity and by 32.4% of patients before the outset of antiretroviral treatment.

This study confirms the high prevalence of sexual dysfunction among HIV-infected men receiving antiretroviral therapy: 71% of patients reported some degree of sexual dysfunction. It has recently been suggested that PI treatment could be responsible for sexual dysfunction in HIV-infected men; however, the researchers found no difference in the prevalence of sexual dysfunction according to whether the HAART regimen contained PIs.

HAART regimens are known to cause adverse effects, but specific studies are required to determine whether particular antiretrovirals can cause sexual dysfunction in some patients. “This determination is important; if sexual dysfunction is indeed caused by HAART or even if patients simply attribute sexual dysfunction to HAART, it may lead to poorer adherence to treatment, with a risk of virologic failure,” the authors wrote. “Given the increased life expectancy of HIV-infected patients since the advent of HAART, their sexuality should no longer be considered only in terms of prevention of transmission. Sexual dysfunction in these patients should be specifically diagnosed and treated as in patients with other chronic diseases such as diabetes, hypertension, and depression,” the researchers concluded.