Background:  HIV-infected men may experience a higher risk of both erectile dysfunction (ED) and hypogonadism than HIV-negative men. We conducted a prospective cohort study to examine the prevalence and predictors of ED and hypogonadism in this population.

Methods:  All HIV-infected men were offered enrollment. Those who consented were offered confidential questionnaires regarding erectile function, hypogonadism, depression, physical activity, and use of sexual stimulants. Medical records were reviewed for ART, CD4, HIV load, duration of HIV infection, and use of medications for ED or hypogonadism. A testosterone level was obtained. Descriptive statistics were performed and correlates for the development of ED were determined by logistic regression (SPSS software).

Results:  Of 65 HIV-infected men, 17 (26%) reported ED. The median age of the cohort was 39 years with a median CD4 of 460 cells/mL; 61% were taking HAART and all of these had a viral load of < 400 copies/mL. Only 3 patients with ED (18%) were taking prescription medications (sildenafil) for ED; 1 patient was taking amyl nitrate. Of those with ED, 59% could not achieve rigid erections adequate for intercourse; 12% had concurrent hypogonadism (testosterone < 300ng/dL); and 36% had depression by Beck criteria. ED was correlated with older age (51 vs 37 years, p < 0.001), longer duration of HIV (11 vs 6 years, p = 0.01), past or current protease inhibitor use (86% vs 50%), longer exposure to ART (98 vs 56 months, p = 0.002), and lipodystrophy (58% vs 20%, p = 0.02). There was a trend toward ED among those with lower CD4 nadir (227 vs 332, p = 0.05). There were no significant differences in current CD4 count, viral load, or physical activity. The cohort’s overall prevalence of hypogonadism by testosterone measurement was 14%; 56% were previously undiagnosed. Utilizing the ADAM questionnaire, an additional 79% had symptoms suggestive of possible hypogonadism.

Conclusions:  ED and hypogonism are more common among HIV-infected men than the general population. Despite evaluating a cohort with free medical care, most cases were unrecognized and untreated. The risk of ED is correlated with increasing age, duration of HIV infection, time on HAART, protease inhibitor use, and the presence of lipodystrophy. Further studies on the pathogenesis of ED and response to therapy are ongoing.

Keywords: Erectile dysfunction; Hypogonadism; HIV Complications