INTRODUCTION: Erectile dysfunction (ED) is more prevalent in men living with HIV (MLHIV) when compared with age-matched HIV-negative men.
This may be related to a premature decline in testosterone levels. In the general population, ED has been associated with an increased risk for coronary heart disease (CHD).
AIM: The aim of this study is to determine the prevalence of ED, testosterone deficiency, and risk of CHD in a cohort of young to middle-aged MLHIV in Belgium.
METHODS: A cross-sectional, observational study among 244 MLHIV attending the outpatient clinic of the Institute of Tropical Medicine in Antwerp.
MAIN OUTCOME MEASURES: The short version of the international index of erectile function (IIEF-5) questionnaire diagnosed ED (cutoff score ≤ 21). The 10-year risk score for CHD was calculated. In a subset of men reporting ED, the calculated free testosterone (CFT) was determined using Vermeulen's formula. Testosterone deficiency was defined as CFT < 0.22 nmol/L.
RESULTS: One hundred fifty-one men (61.9%) self-reported ED (median IIEF-5 score: 16 [interquartile range (IQR) 12-19]). In multivariate analysis, only increasing age, but none of the HIV-related parameters, nor any of the individual cardiovascular-risk related parameters, was statistically significantly associated with ED. Eighteen out of the 49 (36.7%) men with ED who received a blood test to assess testosterone levels were diagnosed with testosterone deficiency. The 10-year risk of CHD in the cohort was 4.3% (IQR 3.6-5.7) and was significantly higher in men with ED (5.1%, IQR 4.4-6.6) compared with men without ED (3.1%, IQR 2.5-4.2).
CONCLUSIONS: This study showed that ED and testosterone deficiency are highly prevalent in young to middle-aged MLHIV and that ED might be associated with an increased risk of CHD. Therefore, healthcare professionals should screen for clinical ED and should consider testing for underlying testosterone deficiency. A clinical diagnosis of ED should trigger a full evaluation of the patient's cardiovascular risk factors, even at younger age.
Written by:
De Ryck I, Van Laeken D, Apers L, Colebunders R. Are you the author?
Department of Clinical Sciences, Institute of Tropical Medicine (ITM), Antwerp, Belgium.
Reference: J Sex Med. 2013 Jul;10(7):1816-22.
doi: 10.1111/jsm.12175
PubMed Abstract
PMID: 23651241
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