NEW YORK (Reuters Health) - Antiretroviral drugs, especially protease inhibitors (PIs), seem to be related to sexual dysfunction in men with HIV infection, according to a prospective analysis conducted in Spain. Neither hypophyseal hypogonadism nor testicular failure appears to play a part, according to the report in the November 1st issue of the Journal of Acquired Immune Deficiency Syndromes.

Dr. Julio Collazos and associates, of Hospital de Galdakao in Vizcaya, evaluated symptoms of sexual dysfunction during 351 evaluations among 189 men. The average patient age was 36.8 years. Although all the men were deemed to be in good clinical condition, the prevalence of sexual dysfunction was 19.5%.

Symptoms such as decreased libido, erectile dysfunction and impaired ejaculation were eight times more likely to be seen in patients receiving antiretroviral therapy compared with untreated patients (p = 0.008). The incidence ranged from 16.7% for patients treated only with nucleoside reverse transcriptase inhibitors (NRTIs) to 27.2% for those on NRTIs plus PIs.

The researchers observed that 13 patients who complained of symptoms at one evaluation reported improvement at a subsequent examination. Nine patients were on PI when sexual disturbance was reported compared with four at the time of symptom improvement (p = 0.049).

In contrast, there was no significant association between hormone levels or psychotropic drug use and sexual problems. Hormones measured at each evaluation were testosterone, 17-beta-estradiol, follicle-stimulating hormone, luteinizing hormone and prolactin.

In a logistic regression analysis that included antiretroviral treatment, hormones, metabolic disturbances, CD4 count and viral load, only antiretroviral treatment was predictive of sexual disturbance.

Several factors may be involved, Dr. Collazos' team suggests. They mention psychogenic factors associated with adverse effects of antiretrovirals on quality of life, neurogenic factors, and interactions between drugs and hormonal receptors.

J Acquir Immune Defic Syndr 2002;31:322-326.

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