Endocrine Abstracts

Background: HIV-infection is associated to an increased prevalence of age-related comorbidities, such as erectile dysfunction (ED) and testosterone (T)-deficiency.

Aim: Definition of ED and T-deficiency in HIV-infected men using validated sexual questionnaires and the gold standard assay for T measurement: isotopic dilution–liquid chromatography–tandem mass spectrometry (ID–LC–MS/MS)

Methodology: Prospective, cross-sectional, observational study on 68 HIV-infected men (mean age=44years) with ongoing highly active antiretroviral therapy (HAART). International index of erectile function (IIEF)-15 questionnaire was used to assess ED, considered for score <25 at erectile domain. Sexual function was studied also by structured interview on erectile dysfunction (SIEDY) questionnaire. ID–LC–MS/MS was used for hormonal assays. Serum total T<300 ng/dl was suggestive for T-deficiency.

Results: IIEF-15 erectile domain is impaired in 60.3% of patients, with a 13.2% of severe form. 11% of subjects declared the use of PDE5-inhibitors. SIEDY organic scale scores were significantly impaired in patients with hypertension (P=0.013) and hepatitis C virus (HCV) infection (P=0.007); psychogenetic scale was impaired only in HCV-infected men (P=0.008). T-deficiency is found in 10% of subjects with a longer time of HIV-infection and HAART. Comparing patients with or without T-deficiency IIEF-15 and SIEDY scores are similar in both groups.

Conclusions: The percentage of ED and T-deficiency is higher and occurs earlier in HIV-infected men than healthy subjects, supporting the hypothesis of premature aging in HIV-infection. However, serum T levels seem to be not correlated with IIEF-15 and SIEDY scores, suggesting that ED should not be directly related to the decline of serum T levels. Thus, HIV-infection itself, age-related comorbidities and psycho-emotional status seem to be the strongest risk factors in the development of ED. Furthermore, neither of validated questionnaires seem to be sufficiently trustworthy in the study of sexual function in HIV-infected men, but SIEDY could be more reliable than IIEF-15 when more comorbidities are present.