Background:  Despite the relatively young age of many HIV-infected men, rates of erectile dysfunction (ED) appear higher than in the general population. The etiology is unclear; during the pre-HAART era, ED was correlated with low CD4 counts and end-stage AIDS. During the HAART era, rates of ED remain high, and some studies have implicated HIV medications. We studied the prevalence and risk factors for ED in a large HIV clinic.

Methods:  Adult HIV-infected men were offered enrollment (September 2004 to May 2005). Data collected included demographics, body mass index, duration of HIV, medical conditions and medications, physical activity, neuropathy, current and nadir CD4 cell count, current HIV viral load, early morning testosterone and fasting cholesterol levels, and alcohol, tobacco, or illicit drug use. All participants completed questionnaires regarding ED (IIEF-15) and depression (Beck). Descriptive statistics were performed and correlates for the development of ED were determined by logistic regression (STATA software 8.0).

Results:  We enrolled 300 patients with a mean age of 39 years (range 19 to 72) and a mean duration of HIV of 9 years (range 0.5 to 20); 60% were receiving ART; mean CD4 count was 522 cells/mm³ (range 1 to 1531). ED was reported by 61.4%; 28% were unable to sustain an erection long enough for intercourse. In the univariate analyses, ED was associated with increasing age (OR 1.4, p <0.001), CDC stage C (OR 4.7, p <0.001), HIV duration (OR 1.1, p <0.001), lower nadir and current CD4 counts (OR 0.8, p <0.001), years of HIV medications (OR 1.1, p <0.001), depression (OR 11.4, p <0.001), diabetes (OR 8.8, p = 0.01), neuropathy (OR 2.8, p = 0.003), lipodystrophy (OR 1.9, p = 0.001), and lack of physical activity (OR 0.3, p = 0.028). In the multivariate analysis, age (OR 1.4, p <0.001), depression (OR 2.6, p <0.0001), and low current CD4 count were predictive of ED (OR 0.8, p = 0.004). There was no association with the current, past, or cumulative use of HIV medications or individual medications including protease inhibitors or lipid lowering therapy.

Conclusions:  ED is common (61%) among HIV-infected men despite their relatively young age (mean 39 years). Increasing age, low current CD4 cell count, and depression are associated with ED among HIV-infected men. Patients presenting with ED should be evaluated for depression. There is no evidence that ART medications are associated with ED.