To determine the prevalence of erectile dysfunction and its associated factors we conducted an observational study on a consecutive cohort of asymptomatic HIV-positive men. All the patients completed a questionnaire to evaluate erectile dysfunction based on the International Index of Erectile Function, a validated survey for the diagnosis of anxiety and depression (self-administered HAD), and a questionnaire about cardiovascular risk factors. Epidemiological, clinical, and analytical data were collected. In all, 158 men, participated: mean age 46.0 years, 96.2% on antiretroviral therapy (91.3% undetectable viral load), and the mean CD4 count was 534 cells/mL. Erectile dysfunction was present in 106 (67.1%) patients, and associated factors were age (OR 4.5 for each 5 years; 95% CI 4.3-4.7; p=0.0001) and anxiety (OR 8.2, 95% CI 2.2-30.4; p=0.002). The prevalence of erectile dysfunction is high in men living with HIV, even in those with good immunovirological control. It is related to increasing age and anxiety, both of which are important factors within our HIV cohort.

HIV infection is considered a risk factor for the development of pulmonary arterial hypertension (PAH) and the estimated prevalence of PAH in developed countries is 0.5%. The aim of this study was to determine the prevalence of PAH in a cohort of HIV-infected patients and the related factors. We undertook an observational study of a consecutive cohort of asymptomatic HIV-infected patients. Data were recorded about factors of cardiovascular interest and factors related to HIV infection. All the patients underwent a transthoracic echocardiogram (Vivid S6, GE Healthcare). PAH was considered to be a pulmonary arterial systolic pressure (PASP) >40 mm Hg. The study included 194 patients (85.2% men) with a mean age of 47.0 years, 94% of whom were on antiretroviral therapy (ART). The mean CD4 lymphocyte count was 495/mm(3). The mean duration of HIV infection was 131.5 months, and 28.4% had experienced an AIDS event. PAH was present in five patients (2.6%) and 14 were in the gray zone (PASP of 36-40 mm Hg). These five patients were men, the route of transmission was homosexual, and they were all on ART. They were also older than the patients without PAH (57.7 vs. 46.4 years, p=0.02) and had been on ART for longer (180.0 vs. 92.5 months; p=0.01). No association was found with any of the other parameters. The prevalence of PAH in this cohort of patients was greater than in other published series. The only associations found were with older age and longer ART time.

Although there is a universally enjoyed right to health care in Spain, some groups of TB patients could nevertheless be experiencing problems in seeking medical attention.

HIV patients have been reported to have a greater prevalence of echocardiographic abnormalities. We aimed to determine the prevalence of these abnormalities and their associated factors. This was an observational study of a cohort of asymptomatic HIV patients. Data were recorded on factors of cardiovascular interest and those related to HIV infection. All the subjects underwent a transthoracic echocardiogram. The study included 196 patients, 85.2% men, mean age 46.4 years, with a mean duration of HIV infection of 123.8 months and 27.6% with AIDS. Of the patients, 94.4% were on antiretroviral therapy and 92.5% of these had an undetectable viral load. The mean CD4 cell count was 544/mm(3). The following echocardiographic abnormalities were found: left ventricular (LV) hypertrophy 28.6%, LV diastolic dysfunction 19.9%, left atrial (LA) dilatation 7.7%, right ventricular (RV) systolic dysfunction 6.1%, pulmonary hypertension 2.6%, RV dilatation 2%, and (LV) systolic dysfunction 1%. LV hypertrophy was associated with diabetes mellitus (OR 5.3, 95% CI 1.8-15.3; p=0.001), LV diastolic dysfunction with age (OR for each extra 5 years 4.4, 95% CI 4.2-4.6; p=0.0001), obesity (OR 4.07, 95% CI 1.6-10.0; p=0.02), alcohol consumption (OR 2.5, 95% CI 1.07-6.2; p=0.03) and lower CD4 cell count (OR for each 10 CD4 cells less 10.02, 95% CI 10.00-10.04; p=0.008), and RV systolic dysfunction with hypertension (OR 5.4, 95% CI 1.6-18.2; p=0.005). Echocardiographic abnormalities in HIV patients were common, especially LV hypertrophy and diastolic dysfunction. Prospective comparative studies involving the general population are needed to determine the prevalence of HIV infection and its treatment in these abnormalities.

Despite free health care being universally available in Spain, there are some groups of TB patients whose treatment is unduly delayed.