ASSESSMENT OF CLINICAL FACTORS AND SERUM TESTOSTERONE ABOUT ERECTILE DYSFUNCTION IN HIV-INFECTED MEN
DOI:
https://doi.org/10.22159/ajpcr.2023.v16i4.46791Keywords:
Erectile dysfunction, HIV, International index of erectile function, Serum testosteroneAbstract
Objective: The objective of this study was to assess and correlate serum testosterone (ST) levels with erectile dysfunction (ED) and associated risk factors in human immunodeficiency virus (HIV)-positive men.
Methods: The present correctional study was conducted among 75 HIV-positive patients. The study subjects were analyzed for ST levels and evaluated for ED using the international index of erectile function (IIEF-5). IIEF score was compared across depression severity assessed using a patient health questionnaire. Other variables, including age, the cluster of differentiation 4 (CD4+) count, antiretroviral treatment therapy, body mass index, and HIV duration, were also correlated with ED concerning ST levels.
Results: The prevalence of ED among HIV-positive patients was 96%. The majority (54.67%) of patients had mild-moderate ED. Hypertension was found in 14.67% of the study population. The mean IIEF score was 16.15±2.93. The relationship between depression severity and IIEF score was statistically significant (p<0.001). A weak positive correlation between CD4+ count and ED was found when ST was average (rs: 0.316, p=0.163). There was no correlation between age and abnormal ST and ED [rs: −0.459, p=0.003]
Conclusion: The prevalence of ED and its effect on ST levels could help in better management among HIV-infected males. Mild-moderate depression played a significant role in causing ED in association with ST levels. The study suggests that testosterone supplementation, along with optimum treatment of depression in HIV patients, can be fruitful in treating ED.
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References
Fumaz CR, Ayestaran A, Perez-Alvarez N, Muñoz-Moreno JA, Ferrer MJ, Negredoe E, et al. Clinical and emotional factors related to erectile dysfunction in HIV-infected men. Am J Mens Health 2017;11:647-53. doi:10.1177/1557988316669041
Global Statistics. HIV.gov. 2021. Available from: https://www.hiv.gov/ hiv-basics/overview/data-and-trends/global-statistics [Last accessed on 2022 Feb 07].
India UNAIDS. Available from: https://www.unaids.org/en/ regionscountries/countries/india [Last accessed on 2022 Feb 07].
Asboe D, Catalan J, Mandalia S, Dedes N, Florence E, Schrooten W, et al. Sexual dysfunction in HIV-positive men is multi-factorial: A study of prevalence and associated factors. AIDS Care 2007;19:955-65. doi:10.1080/09540120701209847
Scanavino MT. Sexual dysfunctions of HIV-positive men: Associated factors, pathophysiology issues, and clinical management. Adv Urol 2011;2011:e854792. doi:10.1155/2011/854792
Zona S, Guaraldi G, Luzi K, Beggi M, Santi D, Stentarelli C, et al. Erectile dysfunction is more common in young to middle-aged HIV-infected men than in HIV-uninfected men. J Sex Med 2012;9:1923-30. doi:10.1111/j.1743-6109.2012.02750.x
Gucci M, Eardley I, Giuliano F, Hatzichristou D, Kaplan SA, Maggi M, et al. Critical analysis of the relationship between sexual dysfunctions and lower urinary tract symptoms due to benign prostatic hyperplasia. Eur Urol 2011;60:809-25. doi:10.1016/j.eururo.2011.06.037
Crum NF, Furtek KJ, Olson PE, Amling CL, Wallace MR. A review of hypogonadism and erectile dysfunction among HIV-infected men during the pre- and post-HAART eras: Diagnosis, pathogenesis, and management. AIDS Patient Care STDs 2005;19:655-71. doi:10.1089/ apc.2005.19.655
Savasi V, Parisi F, Oneta M, Laoreti A, Parrilla B, Duca P, et al. Effects of highly active antiretroviral therapy on semen parameters of a cohort of 770 HIV-1 infected men. PLoS One 2019;14:e0212194. doi:10.1371/ journal.pone.0212194
Gomes AC, Aragüés JM, Guerra S, Fernandes J, Mascarenhas MR. Hypogonadotropic hypogonadism in human immunodeficiency virus-infected men: Uncommonly low testosterone levels. Endocrinol Diabetes Metab Case Rep 2017;2017:17-0104. doi:10.1530/EDM-17-0104
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med 2001;16:606-13. doi:10.1046/j.1525-1497.2001.016009606.x
Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res 1999;11:319-26. doi:10.1038/SJ.jar.3900472
Turek PJ. Male reproductive physiology. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, editors. Campbell-Walsh Urology. Vol. 1. Philadelphia, PA: Elsevier Saunders; 2012. p. 591-615.e5. doi: 10.1016/ B978-1-4160-6911-9.00020-7
Hafez B, Hafez ES. Andropause: Endocrinology, erectile dysfunction, and prostate pathophysiology. Arch Androl 2004;50:45-68.
Gomes AR, Souteiro P, Silva CG, Sousa-Pinto B, Almeida F, Sarmento A, et al. Prevalence of testosterone deficiency in HIV-infected men under antiretroviral therapy. BMC Infect Dis 2016;16:628. doi:10.1186/ s12879-016-1892-5
Shindel AW, Horberg MA, Smith JF, Breyer BN. Sexual dysfunction, HIV, and AIDS in men who have sex with men. AIDS Patient Care STDs 2011;25:341-9. doi:10.1089/apc.2011.0059
Martin J, Volberding P. HIV, and premature aging: A field still in its infancy. Ann Intern Med 2010;153:477-9. doi:10.7326/0003-4819-153- 7-201010050-00013
The National Institutes of Health (NIH) Consensus Development Program: Impotence. Available from: https://consensus.nih. gov/1992/1992Impotence091html.htm [Last accessed on 2022 Feb 04].
Aggarwal J, Taneja RS, Gupta PK, Wali M, Chitkara A, Jamal A. Sex hormone profile in human immunodeficiency virus-infected men and its correlation with CD4 cell counts. Indian J Endocrinol Metab 2018;22:328-34. doi:10.4103/item.IJEM_694_17
Lamba H, Goldmeier D, Mackie NE, Scullard G. Antiretroviral therapy is associated with sexual dysfunction and increased serum oestradiol levels in men. Int J STD AIDS 2004;15:234-7. doi:10.1258/095646204773557749
De Ryck I, Van Laeken D, Nöstlinger C, Platteau T, Colebunders R, The Eurosupport Study Group. Sexual satisfaction among men living with HIV in Europe. AIDS Behav 2012;16:225-30. doi:10.1007/s10461- 011-9987-x
Rosen RC, Seidman SN, Menza MA, Shabsigh R, Roose SP, Tseng LJ, et al. Quality of life, mood, and sexual function: A path analytic model of treatment effects in men with erectile dysfunction and depressive symptoms. Int J Impot Res 2004;16:334-40. doi:10.1038/sj.ijir.3901197
Goldmeier D, Scullard G, Kapembwa M, Lamba H, Frize G. Does increased aromatase activity in adipose fibroblasts causes low sexual desire in patients with HIV lipodystrophy? Sex Transm Infect 2002;78:64-6. doi:10.1136/sti.78.1.64
Collazos J, Martínez E, Mayo J, Ibarra S. Sexual dysfunction in HIV-infected patients treated with highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2002;31:322-6. doi:10.1097/00126334- 200211010-00008
Ende AR, Lo Re V, DiNubile MJ, Mounzer K. Erectile dysfunction in an urban HIV-positive population. AIDS Patient Care STDs 2006;20:75-8. doi:10.1089/apc.2006.20.75
Pongener N, Salam R, Ningshen R, Visi V, Wairokpam T, Devi LS. A study on hypogonadism in male HIV patients in the northeastern part of India. Indian J Sex Transm Dis AIDS 2019;40:20-4. doi:10.4103/IJ std.IJSTD_67_17
Jain N, Mittal M, Dandu H, Verma S, Gutch M, Tripathi A. An observational study of endocrine disorders in HIV-infected patients from North India. Indian J Endocrinol Metab 2013;17:846-9. doi:10.4103/2321-9157.116535
Rietschel P, Corcoran C, Stanley T, Basgoz N, Klibanski A, Grinspoon S. Prevalence of hypogonadism among men with weight loss related to human immunodeficiency virus infection who received highly active antiretroviral therapy. Clin Infect Dis 2000;31:1240-4. doi:10.1086/317457
Rochira V, Zirilli L, Orlando G, Santi D, Brigante G, Diazzi C, et al. Premature decline of serum total testosterone in HIV-infected men in the HAART-era. PLoS One 2011;6:e28512. doi:10.1371/journal. pone.0028512
Liao M, Huang X, Gao Y, Tan A, Lu Z, Wu C, et al. Testosterone is associated with erectile dysfunction: A cross-sectional study in Chinese men. PLoS One 2012;7:e39234. doi:10.1371/journal.pone.0039234
Kocoglu H, Alan C, Soydan H, Ateş F, Adayener C, Eren AE, et al. Association between the androgen levels and erectile function, cognitive functions and hypogonadism symptoms in aging males. Aging Male 2011;14:207-12. doi:10.3109/13685538.2011.617798
Corona G, Mannucci E, Ricca V, Lotti F, Boddi V, Bandini E, et al. The age-related decline of testosterone is associated with different specific symptoms and signs in patients with sexual dysfunction. Int J Androl 2009;32:720-8. doi:10.1111/j.1365-2605.2009.00952.x
Kang JI, Ham BK, Oh MM, Kim JJ, Moon DG. Correlation between serum total testosterone and the AMS and IIEF questionnaires in patients with erectile dysfunction with testosterone deficiency syndrome. Korean J Urol 2011;52:416-20. doi:10.4111/kju.2011.52.6.416
Huang YP, Liu W, Chen SF, Liu YD, Chen B, Deng CH, et al. Free testosterone correlated with erectile dysfunction severity among young men with normal total testosterone. Int J Impot Res 2019;31:132-8. doi:10.1038/s41443-018-0090-y
Meena LP, Rai M, Singh SK, Chakravarty J, Singh A, Goel R, et al. Endocrine changes in male HIV patients. J Assoc Physicians India 2011;59:365-6, 371.
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