Erectile dysfunction common in men with HIV, PIs a cause

Michael Carter
Published: 03 December 2009

The majority of HIV-positive men receiving care in a Spanish HIV clinic had erectile dysfunction, Spanish investigators report in a study published in the online edition of AIDS. Older age and treatment with protease inhibitors were both significantly associated with erectile problems.

“Erectile dysfunction is common in HIV-infected men. The prevalence of erectile dysfunction in our study was 53.4%, similar to that obtained in other HIV-positive cohorts”, comment the investigators.

Erectile dysfunction is defined as the inability to achieve or maintain an erection that is satisfactory for the completion of sexual intercourse.

Earlier research has suggested that between a third and three-quarters of HIV-positive men live with this problem. Such a rate is significantly higher than that seen in age-matched HIV-negative men.

The exact causes of erectile dysfunction in patients with HIV are poorly understood. However, they could include the effects of HIV infection itself, treatment with antiretroviral drugs – most especially protease inhibitors - , and traditional risk factors such as age.

To gain a better understanding of the prevalence and risk factors for erectile dysfunction, Spanish investigators undertook a cross-sectional, or “snap-shot” study involving 90 men who were receiving HIV care.

Prevalence of erectile dysfunction was assessed using a validated questionnaire.

The investigators also enquired about the presence of sexual dysfunction – defined as a lack of sexual satisfaction.

Information was also obtained on possible risk factors including age, testosterone levels, duration of HIV infection, use of antiretroviral drugs, type of anti-HIV drugs taken, treatment side-effects such as lipodystrophy, and symptoms of depression.

Average age was 42 years, and 76 (84%) patients were taking antiretroviral therapy. A protease inhibitor was being taken by 39 (43%) patients. Mean CD4 cell count was near normal at 465 cells/mm3 and 72% had an undetectable viral load.

“Impotence” was reported by 31% of patients, and three quarters of these patients said that this was progressive.

However, a much higher prevalence of erectile dysfunction was detected using the validated questionnaire.

This showed that 53.4% of patients had experienced erectile dysfunction ranging from mild to severe.

Statistical analysis showed that the only risk factors significantly associated with erectile dysfunction were older age (44 years vs. 39 years, p = 0.014) and longer duration of treatment with a protease inhibitor (mean 6 years vs. 3 years, p = 0.029).

Both older age (p = 0.01) and treatment with a protease inhibitor (p = 0.04) remained significantly associated with erectile dysfunction when the investigators restricted their analysis to patients with longer duration of HIV infection (mean, 13 years).

Furthermore, older age and therapy with a protease inhibitor were also significantly associated with lower overall sexual satisfaction scores, as were depression and lipodystrophy.

Although the investigators did not find any statistically significant association between specific testosterone levels and erectile dysfunction due to the probability that testosterone levels are routinely over-estimated in men with HIV, they noted that all the patients with low testosterone levels reported erectile dysfunction. They call for further research to investigate the relationship between testosterone and erectile problems.

Although several oral treatments for erectile dysfunction are now available, only eleven patients reported taking them. Most of the men (80%) who did receive such therapies reported that they were effective.

The investigators emphasise the importance of monitoring and understanding erectile dysfunction in men with HIV. They write that not only can erectile dysfunction lower the quality of life, but can also be an early warning sign of heart disease.


Moreno-Perez O et al. Risk factors for sexual and erectile dysfunction in HIV-infected men: the role of protease inhibitors. AIDS 23 (online edition), 2009.

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