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Erectile Dysfunction Drug Use Doubles Odds of Syphilis in US Men With HIV
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Erectile Dysfunction Drug Use Doubles Odds of Syphilis in US Men With HIV
53rd ICAAC, September 10-13, 2013, Denver
Mark Mascolini
Using erectile dysfunction drugs (EDDs) doubled chances of syphilis in a cross-sectional study of 872 HIV-positive men seen at the Albany Medical Center [1]. Medical records showed that 15% of men had an EDD prescription, and almost 14% of those men had syphilis.
Erectile dysfunction affects one quarter of HIV-positive men in the Swiss HIV Cohort Study "often" or "sometimes" [2]. Men who have sex with men (MSM) with and without HIV use EDDs to correct dysfunction or enhance pleasure during sex. Use of these agents has been associated with increased sexual risk behavior in some studies of men with HIV [3] but not in others [4].
To learn more about erectile dysfunction drug use and sexual risk taking in men with HIV, researchers at Albany Medical Center conducted this cross-sectional study of HIV-positive men at least 18 years old and in care during the period 2007-2010. The investigators examined medical records for demographic data, comorbidities, recreational drug and alcohol use, and clinical variables. They recorded documented prescriptions of three erectile dysfunction drugs-sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra).
Of the 872 men in the cohort, 131 (15%) got a prescription for an erectile dysfunction drug (EDD). Average age was significantly older in EDD users than nonusers (52.1 versus 48.1, P < 0.001), but racial distribution was similar in the two groups (just under half white and about one third black). EDD users weighed more than nonusers (189.3 versus 178.7 lb, P = 0.002), and a higher proportion of users had hypertension (46.6% versus 37.1%, P = 0.04), dyslipidemia (46.6% versus 34.7%, P = 0.01), or cancer (16.8% versus 9.9%, P = 0.02). The two groups did not differ significantly in mental health disorders recorded. High proportions in both groups used recreational drugs, but the proportion was significantly lower in EDD users (64.9% versus 77.1%, P = 0.003).
Similar high proportions of EDD users and nonusers were taking antiretrovirals (89.3% and 84.8%, P = 0.17). Among antiretroviral-treated men, syphilis prevalence stood at about 15% among EDD users and 7% among nonusers, a significant difference (P = 0.003). Among men not taking antiretrovirals, none used EDDs. Among men younger than 45, syphilis prevalence did not differ significantly between men taking and not taking EDDs. But among men 45 or older, a significantly higher proportion taking than not taking EDDs had syphilis (about 15% versus 7%, P = 0.007).
Overall syphilis prevalence was significantly higher in men who used EDDs than in those who did not (13.7% versus 7.8%, P = 0.03). Logistic regression analysis adjusted for age and recreational drug use determined that EDD takers had doubled odds of syphilis (adjusted odds ratio 1.98, 95% confidence interval 1.11 to 3.55, P = 0.02). In the same analysis, neither age nor recreational drug use affected chances of syphilis.
The researchers cautioned that they may have underestimated syphilis prevalence because they relied on medical records to indicate syphilis. And they may have underestimated EDD use because they did not consider EDDs obtained without a prescription. The investigators also stressed that a cross-sectional analysis like this cannot ascertain causality--only an association between having a prescription for erectile dysfunction drugs and having a record of syphilis. They suggested that further research on these issues should adjust statistical analyses for sexual practices, condom use, and number of coital events.
References
1. Patel N, Nasiri M, Kwon S, et al. Association between use of erectile dysfunction drugs and syphilis among HIV-infected men. 53rd ICAAC. September 10-13, 2013. Denver. Abstract H-1265.
2. Wang Q, Young J, Bernasconi E, et al. The prevalence of erectile dysfunction and its association with antiretroviral therapy in HIV-infected men: the Swiss HIV Cohort Study. Antivir Ther. 2013;18:337-344.
3. De Ryck I, Van Laeken D, Noestlinger C, Platteau T, Colebunders R. The use of erection enhancing medication and party drugs among men living with HIV in Europe. AIDS Care. 2013;25:1062-1066.
4. Cook RL, McGinnis KA, Samet JH, et al. Erectile dysfunction drug receipt, risky sexual behavior and sexually transmitted diseases in HIV-infected and HIV-uninfected men. J Gen Intern Med. 2010;25:115-121.
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