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Sexual Function Worse With HIV Than Diabetes or
No Chronic Illness in Older Men
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First International Workshop on HIV and Aging, October 4-5, 2010, Baltimore
Mark Mascolini
Among men 50 or older, those with HIV were more than twice as likely to have severe perceived reduced sexual function than men with type 2 diabetes or men with no severe chronic or malignant disease in a German study [1]. By a broader measure of psychological, somatic, and sexual complaints, men over 50 with HIV or diabetes were more likely to perceive moderate to severe problems than men without chronic disease.
Researchers compared somatic, psychological, and sexual function in a national prospective cohort of men 50 or older including 175 with HIV, 165 HIV-negative men with diabetes mellitus, and 165 men in a control group with no severe chronic or malignant disease. People in the control group could have hypertension, hepatitis C virus infection, a history of myocardial infarction, and certain other conditions. No one in any of the study groups had acute life-threatening disease or malignant disease.
The investigators used two tools to rate perceived well-being. (1) The Aging Male Symptoms Scale (AMS) is a 17-item questionnaire with a total score ranging from 17 to 85. A score of 37 or higher indicates moderate to severe perceived somatic, psychological, and sexual complaints. (2) The AMS-S is a 5-item sexual subscale with a total score range of 5 to 25. An AMS-S score of 11 or higher indicates severely reduced sexual function.
Median age was higher in the diabetes group (59.1) than in the HIV group (57.7) or the control group (57.1) (P = 0.006). Median body mass index was 24 kg/m(2) in men with HIV, compared with 30 kg/m(2) in men with diabetes and 26 kg/m(2) in the control group (P < 0.001). Body mass index lay above 28 kg/m(2) in a lower proportion of men with HIV (17%) than in men with diabetes (65%) or men with no chronic condition (27%) (P < 0.001).
Median AMS score stood at 37 in men with HIV, 34 in men with diabetes, and 31 in men with no chronic disease, a highly significant difference (P < 0.001). Half of the men with HIV versus 45% with diabetes and 28% of controls reported moderate or severe complaints (an AMS score at or above 37, P < 0.001).
Multivariate statistical analysis adjusted for stable partnership, body mass index, and age determined that men with HIV had a doubled risk of an AMS score at or above 37 (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.4 to 3.4, P < 0.001) compared with the control group. Men with diabetes also had almost a doubled risk of an AMS score at or above 37 compared with controls (OR 1.9, 95% CI 1.2 to 3.0, P < 0.01). Men without a stable partnership had a 70% higher risk of an AMS score at or above 37 (OR 1.7, 95% CI 1.2 to 2.6, P < 0.01). Body mass index and age 60 to 69 or 70 to 79 (versus 50 to 59) did not affect risk of complaints in this analysis.
Median AMS-S score measured 11 in men with HIV, 10 in men with diabetes, and 9 in controls (P < 0.001). An AMS-S score of 11 or higher, indicating severe sexual dysfunction, was reported by 52% of men with HIV, 48% of men with diabetes, and 33% of the control group (P = 0.001). Multivariate analysis that factored in stable partnership, body mass index, and age identified HIV infection (but not diabetes) as an independent risk factor for severe sexual dysfunction by the AMS-S score (OR 2.1, 95% CI 1.4 to 3.3, P = 0.001). Men over 70 had more than a 4 times higher risk of an AMS-S score of 11 or higher (OR 4.5, 95% CI 2.4 to .82, P < 0.001). No other variables independently predicted a high AMS-S score in this analysis.
Notably, the investigators did not attempt to match the three groups by sexual preference. London clinician Mike Youle observed that, at least in his experience, gay men tend to have a different view of good sexual function than straight men. If that is true for this population, the HIV group could have a reporting bias for sexual dysfunction.
Reference
1. Mueck B, Koegl C, Wolf E, et al. Sexual dysfunction in an aging HIV positive population compared to HIV negative control groups. Results from the German 50/2010 cohort study. First International Workshop on HIV and Aging. October 4-5, 2010. Baltimore. Abstract O_10.
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