Erectile Dysfunction is Not a Mirror of Endothelial Dysfunction in HIV-Infected Patients

Abstract

Introduction The penis has been compared to a barometer of endothelial health, erectile dysfunction (ED) being an early sign of endothelial dysfunction. Aim The aim of the study was to investigate the extent of the association between ED and endothelial dysfunction in patients with human immunodeficiency virus (HIV) infection on antiretroviral therapy. Methods In this observational cross-sectional study, we evaluated the prevalence and factors associated with ED in a cohort of 133 HIV-infected men. Main Outcome Measures The International Index of Erectile Function, ultrasound assessment of brachial artery flow mediated dilatation (FMD), and multi-slice computed tomography for coronary artery calcifications (CAC) as surrogates of endothelial dysfunction, the Adult Treatment Panel III criteria to diagnose metabolic syndrome (MS), plasma total testosterone (hypogonadism), and a visual analogue scale (VAS) of aesthetic satisfaction of the face and of the body (psychological distress associated with lipodystrophy). Results Thirty-nine (29.32%) patients had mild ED, 14 (10.52%) patients had moderate ED, and 26 (19.55%) patients had severe ED. Prevalence of ED ranged from 45% to 65%, respectively, in patients less than 40 and more than 60 years old. MS was present in 20 (25%) patients with ED and 13 (24%) patients without ED (P value = 0.87). Prevalence of ED neither appeared to be associated with MS as a single clinical pathological entity nor with the numbers of its diagnostic components. FMD < 7% was present in 25 (32%) patients with ED and 18 (33%) patients without ED (P value = 0.83), and CAC > 100 was present in 8 (10%) patients with ED and 5 (9%) patients without ED (P value = 0.87). A stepwise multivariable logistic regression analysis was used to find predictors of ED. Independent predictors were VAS face (odds ratio [OR] = 0.85, 95% confidence interval [CI] 0.73–0.99, P = 0.049) and age per 10 years of increase (OR = 1.73, 95% CI 1.02–2.94, P = 0.04). Conclusions Age constituted the most important risk factor for ED, which was related to aesthetic dissatisfaction of the face leading to negative body image perception.

Erectile Dysfunction Is More Common in Young to Middle‐Aged HIV‐Infected Men than in HIV‐Uninfected Men

“…This is the first study comparing the prevalence of ED in HIV‐infected men and HIV‐uninfected men, and it demonstrates an increased prevalence of ED in men with the HIV infection. Hence, the results of the present study confirm initial results previously reported by this group and other authors [11–14,18,19].…”

“…Accordingly, the role of hypogonadism in causing ED is confirmed in this study but seems to be less pronounced than expected in the setting of HIV, as confirmed by previous studies [13,14,19]. Second, various psychological factors including the fear of HIV transmission and changes in body image may affect sexual desire [11,12,18]. Hence, sexual desire needs to be further investigated in the context of HIV by using much more precise tools for “desire.”…”

“…BMI is an unsophisticated clinical tool both associated with an increased cardiometabolic risk profile and body image perception. Previous studies from our group failed to demonstrate an association between ED and cardiometabolic and endothelial dysfunction parameters [18] while they stressed the importance of body image alteration, especially when associated with clinical lipodystrophy [12,18]. In general, classical factors associated with ED in the general population such as overweight [2,3,27], obesity [2,3,27], hypogonadism [1–3], cardiometabolic, and endothelial dysfunction [25,26] seem to exert a much less pronounced impact on ED in HIV‐infected men than expected [18,19].…”

“…As compared with previous studies, the main result in this setting is that ED is extremely common even among HIV‐infected men younger than 50, thus suggesting that ED should be of concern to clinicians when managing young to middle‐aged HIV‐infected men. Similarly, data from other uncontrolled studies speak in favor of a premature ED onset in HIV‐infected men [11,13,14,18,19]. Conversely, ED is uncommon in the general population before the age of 50 [3,6,7,20,21].…”

Hypogonadism in Human Immunodeficiency Virus-Positive Men

“…In particular, erectile dysfunction (ED) is prevalent and has been reported to be present in between 9% and 74% of HIV-positive men [28]. In that study, Guaraldi et al [28] studied 133 HIV-positive men and found prevalence rates of ED of 55% and 65% of men aged less than or more than 50 years old, respectively. Comparison of TT and FT was made in those with and those without ED and no significant differences were observed.…”