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Delayed ART, Smoking, Sleep Apnea, PI, (CVD) Tied to Erectile Dysfunction With HIV
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Viagra & Melanoma / Hearing-Vision Risk - Role of Sildenafil in Melanoma Incidence and Mortality - (09/20/18)
Delayed ART, Smoking, Sleep Apnea Tied to Erectile Dysfunction With HIV
Sleep Apnea: https://www.webmd.com/sleep-disorders/sleep-apnea/sleep-apnea
IDWeek 2018, October 3-7, 2018, San Francisco
Mark Mascolini
Longer time between HIV diagnosis and antiretroviral therapy (ART) boosted odds of erectile dysfunction in a case-control comparison of US military personnel with HIV [1]. Other predictors of erectile dysfunction were smoking, sleep apnea, and longer protease inhibitor (PI) use.
Erectile dysfunction can predict cardiovascular disease in the general population and is associated with older age, smoking, hypertension, and obesity. Incidence of erectile dysfunction and its risk factors in men with HIV are incompletely understood. In a 4064-man Swiss HIV Cohort Study analysis, 24% of men reported erectile dysfunction often or sometimes [2]. Older age, earlier HIV diagnosis, and depression were associated with erectile dysfunction. Older age and anxiety predicted erectile dysfunction in a Spanish study, and two thirds of the 158 men reported the problem [3].
Researchers at the San Antonio Military Medical Center and collaborators at other sites conducted this case-control comparison to get a better understanding of erectile dysfunction in men with HIV. They drew from the US Military HIV Natural History Study, a 6700-person observational cohort with members from 7 Department of Defense facilities in the United States. Cases were men diagnosed with erectile dysfunction after testing positive for HIV. For every case patient the researchers selected 2 age-matched controls with HIV but without erectile dysfunction. They used multivariate logistic regression to identify erectile dysfunction risk factors.
The 488 cases and 976 controls had a median age of 32 at HIV diagnosis and median CD4 counts of 523 and 508 at diagnosis. Men with erectile dysfunction had a median age of 43 at diagnosis of that condition, and 91% were taking antiretroviral therapy (ART) at diagnosis. Median time from HIV diagnosis to ART was 5 years in cases and 3 years in controls (P < 0.001). Respective proportions of whites were 46% and 44%, blacks 44% and 43%, and Hispanics 7% and 9%.
Compared with controls, erectile dysfunction cases had a higher prevalence of depression (33% versus 22%, P < 0.001), hypertension (38% versus 20%, P < 0.001), hyperlipidemia (54% versus 32%, P < 0.001), diabetes (8% versus 4%, P < 0.001), sleep apnea (15% versus 4%, P < 0.001), and smoking (20% versus 8.5%, P < 0.001). Compared with controls, men with erectile dysfunction had a longer time from HIV diagnosis to starting ART (46% versus 26% above median time, P < 0.001) and a lower proportion with a sub-200 CD4 count at HIV diagnosis (2.7% versus 5.9%, P = 0.006). Significantly more men with erectile dysfunction had taken a PI for more than 1 year (49% versus 18.5%, P < 0.001).
Multivariate analysis pinpointed 4 independent predictors of erectile dysfunction, at the following odds ratios (OR) and 95% confidence intervals (CI):
-- More than 4 y from HIV diagnosis to ART: OR 2.050, 95% CI 1.556 to 2.706, P < 0.001
-- PI use for more than 1 year: OR 1.810, 95% CI 1.376 to 2.381, P < 0.001
-- Smoking: OR 1.600, 95% CI 1.137 to 2.233, P = 0.007
-- Sleep apnea: OR 2.600, 95% CI 1.675 to 4.005, P < 0.001
There were trends to associations between 2 other variables and erectile dysfunction: Hypertension raised odds almost 30% (OR 1.280, 95% CI 0.962 to 1.694, P = 0.090), while CD4 count below 200 at HIV diagnosis lowered odds about 30% (OR 0.570, 95% CI 0.288 to 1.122, P = 0.104).
Noting that delayed ART predicted erectile dysfunction in this analysis and that other studies linked delayed ART to cardiovascular disease, the researchers surmised that "erectile dysfunction may present as an early and only indicator of cardiovascular disease." They suggested that PI therapy may contribute to metabolic syndrome, a risk factor for erectile dysfunction in other studies.
References
1. Jansen N, Daniels C, Sunil TS, et al. Factors associated with erectile dysfunction diagnosis in HIV-infected individuals: a case-control study. IDWeek 2018, October 3-7, 2018, San Francisco. Abstract 602. Poster at https://idsa.confex.com/idsa/2018/webprogram/Paper71936.html
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. Perez I, Moreno T, Navarro F, Santos J, Palacios R. Prevalence and factors associated with erectile dysfunction in a cohort of HIV-infected patients. Int J STD AIDS. 2013;24:712-715.
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Factors Associated with Erectile Dysfunction Diagnosis in HIV-infected Individuals: A Case-control Study
Nathan Jansen, DO1, Colton Daniels, MS2, Thankam Sunil, PhD, MPS 2, Xiaohe Xu, PhD2, Jason Cota,Pharm.D, MS1,3, Morgan Byrne, MPH4, Anuradha Ganesan, MD, MPH4, Robert Deiss, MD4, Brian Agan, MD4,5, Jason Okulicz, MD1
1SanAntonio Military Medical Center, Fort Sam Houston, TX, USA; 2University of Texas San Antonio, Department of Sociology, San Antonio TX, USA; 3University of the Incarnate Word FeikSchool of Pharmacy, San Antonio TX, USA;4Infectious Disease Clinical Research Program, Uniformed Services University of Health Sciences, Rockville, MD, USA;5The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
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