LAUSR

BACKGROUND Sexual dysfunctions, particularly erectile dysfunction (ED), are common in men living with HIV (MLWH), whose organic and psychological components remain to be clarified. The aim of the study is to investigate the impact of risk factors of sexual dysfunctions, including organic, relational and psychological determinants of erectile function, in MLWH younger than 50 years old. METHODS A cross-sectional, observational study was conducted in MLWH <50 years. The questionnaire International Index of Erectile Function (IIEF)-15 was used to assess prevalence and degree of ED. The Structured Interview of Erectile Dysfunction (SIEDY) was used to explore the organic (Scale1), relational (Scale2) and psychological (Scale3) components of ED. Total testosterone (TT), estradiol (E2) and dihydrotestosterone (DHT) were measured by liquid chromatography-tandem-mass spectrometry (LC-MS/MS); free testosterone (cFT) was calculated by Vermeulen equation. RESULTS A total of 313 consecutive MLWH were prospectively enrolled (median age 47.0 years; median HIV-infection duration 16.2 years). 187 patients (59.7%) had ED, with higher prevalence non-heterosexual (138 out of 187, 73.8%) than heterosexual patients (p = 0.003). Patients with ED showed a worse score of SIEDY scale 3 compared to patients without ED (p = 0.025); IIEF-15 was inversely related to SIEDY scale 3 (p = 0.042). No difference was found for sex steroids (TT, cFT, E2, DHT) between MLWH with and without ED. At the multivariate analysis sexual orientation, lack of stable relationship were major determinants for ED. Only 35 of 187 patients with ED (18.7%) reported the use of ED medications. CONCLUSIONS Within the multidimensional network of ED in MLWH, the psychological component is predominant, highlighting the contribution of peculiar factors related to HIV distress (e.g., fear of virus transmission, stigma) rather than gonadal status and other classical risk factors. In contrast to the high prevalence, only few patients reported the use of ED medications suggesting a general under-management of such issues. This article is protected by copyright. All rights reserved.