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  ID Week
Oct 8-12 2014
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Erectile Dysfunction Drug Use Tied to Sexual Risk and STIs in HIV+ US Men
  IDWeek 2014, October 8-12, 2014, Philadelphia
Mark Mascolini
Greater sexual risk taking, substance abuse, and a history of sexually transmitted infection (STI) proved more likely in 1170 HIV-positive men prescribed erectile dysfunction drugs (EDD) at the University of Alabama at Birmingham (UAB) HIV clinic [1]. Syphilis incidence was high in men taking EDD, while screening for other STIs was low.
Previous research found links between EDD use--especially recreational use--and greater sexual risk behavior and STI rates. Because little is known about sexual risk behavior, STI screening, and STI incidence in HIV-positive men taking prescribed EDDs, UAB researchers conducted this cross-sectional study.
The analysis involved HIV-positive men at least 19 years old, in care at the UAB clinic for more than 1 year, and with at least two visits at least 90 days apart in the year before the most recent visit. The investigators included only white and African-American men because numbers of other groups were too small for analysis.
Among 1170 men studied, 269 (23%) had an EDD prescription. Among those men, age averaged 50, 41% were African American, 73% men who have sex with men (MSM), and 27% heterosexual. EDD prescription prevalence was similar in MSM (22%) and heterosexual men (26%). Most men with an EDD prescription (88%) had a viral load below 200 copies.
Among 236 men prescribed EDD who completed a survey on sexual risk behavior, 67% had more than one sex partner, 27% had sex after alcohol or drug user, 21% reported sex without a condom, and 65% had a previous STI. Among 253 men with protocol-driven syphilis screening, 9 (4%) tested positive for new infection. Only 31% of heterosexual men and 28% of MSM had annual testing for gonorrhea or chlamydia. Three men tested positive for gonorrhea and 1 for chlamydia.
Multivariate analysis identified four independent predictors of prescription EDD use at the following adjusted prevalence ratios and 95% confidence intervals:
-- Age over 50: aPR 1.46, 95% CI 1.18 to 1.82, P < 0.001
-- Current substance abuse: aPR 1.55, 95% CI 1.10 to 2.19, P < 0.03
-- One or more sex risk behaviors: aPR 1.95, 95% CI 1.51 to 2.52, P < 0.001
-- Prior STI: aPR 1.35, 95% CI 1.08 to 1.68, P < 0.03
Factors not linked to EDD use in this analysis included sexual orientation, race, insurance status, and viral load.
The UAB investigators concluded that prescription EDD use was significantly associated with sexual risk behavior, substance abuse, and prior STI in HIV-positive men. They advised increased gonorrhea and chlamydia screening for men with HIV and counseled that prescription EDD for HIV-positive men "should be accompanied by assessment and counseling regarding sexual risk behaviors and illicit drug use."
1. Heudebert JP, Maya Tong C, Tamhane A, et al. Prescription erectile dysfunction medication, sexual risk behaviors, and sexually transmitted infections among HIV positive men. IDWeek 2014. October 8-12, 2014, Philadelphia. Abstract 1587.