Erectile dysfunction (or impotence) is when you cannot get or keep an erection that enables you to have sex. Previous studies have shown that it is more common in men living with HIV.
There may be physical or psychological causes, or more frequently a combination of the two. Factors such as dealing with a new diagnosis, stigma, and anxiety about passing on HIV may impact upon your ability to get hard or stay hard. Physical causes may include older age, diabetes, heart disease, taking certain types of HIV medication and how long you have taken these medications.
A group of researchers have been collecting data on US military personnel (serving or retired) who are living with HIV for over 20 years. They recently found that just under 10% had been diagnosed with erectile dysfunction. To see what the causes might be, they compared 543 men who had erectile dysfunction with a group of HIV-positive men who did not have it.
They identified four risk factors. One was starting HIV treatment more than four years after HIV diagnosis (unfortunately quite common as many of the men in the study had been diagnosed in the 1980s or 1990s). Despite the benefits of starting treatment, the study also found that taking anti-HIV drugs known as protease inhibitors increased the risk of erectile dysfunction. In most cases, this was the protease inhibitors that were commonly used in the 1990s and early 2000s, rather than more recent versions that are probably safer.
There are strong links between heart disease and erectile dysfunction, reflected in the last two risk factors: smoking and sleep apnoea. The latter is a potentially serious sleep disorder in which breathing repeatedly stops and starts. Studies with HIV-negative men have shown it to be linked with both heart disease and erectile dysfunction.
The researchers say that doctors should ask men with HIV about erection problems in order to offer support. They say that erectile dysfunction can be an early sign of potentially serious cardiovascular events in the future.
On Monday 7 June, join us on Facebook and Twitter at 6pm (UK time) for aidsmapCHAT, our news broadcast for people living with HIV. NAM’s Susan Cole and Matthew Hodson will be talking to consultant physician in sexual health and HIV at Barts Health NHS Trust, Dr Rageshri Dhairyawan; human rights activist Deondre B. Moore from Prevention Access Campaign; and co-founder of Access to Medicines Ireland, Robbie Lawlor.
Catch up with the last episode featuring actor and writer Charles Sanchez, HIV activist Lucy Wanjiku Njenga and Chair of the British Association for Sexual Health & HIV, Dr John McSorley, on aidsmap.com and our social media channels.
HIV and ageing
Some research suggests that people living with HIV might age prematurely or more markedly than other people. In other words, their biological age (how well their body functions) might be greater than their chronological age (how many years they have lived).
This is probably linked to the immune system deterioration and inflammation that persists in people living with HIV, despite successful HIV treatment.
A recent study measured biological age in people who were previously untreated and then took HIV treatment, comparing them with a group of HIV negative people. The results suggest that untreated HIV infection is associated with biological age acceleration, which is more pronounced in people with CD4 counts below 200.
This effect was partly reversed by HIV treatment only two years after starting it. Unfortunately, the researchers only have data on people’s first two years on treatment: it would be interesting to see whether the accelerated ageing would be fully reversed by a longer period of HIV treatment.
Feelings about sex after your HIV diagnosis
Good sex, intimacy and physical pleasure are integral aspects of wellbeing. Your HIV status does not take away your right to intimacy and pleasure. Learn more about feelings around sex after being diagnosed with HIV in our About HIV page.
Weight gain and HIV treatment
Lots of studies have found that people often put on some weight in the first year or two of starting a modern HIV treatment regimen. While this is more likely with some anti-HIV drugs than others, the medications are not the only factor associated with weight gain. A lower CD4 count, Black race, female sex, and baseline weight are also associated with weight gain. Some of the weight gained after starting treatment may be a 'return to health' effect, especially in people with more advanced HIV disease or lower body weight.
To better understand the issue, some scientists have suggested looking at studies of people who switch from one regimen to another, as this group of people will already have experienced any 'return to health' weight gain on their first antiretroviral regimen. The results of an analysis of 12 different switch studies has just been published.
The researchers found that gaining weight after switching to a new antiretroviral combination is common, but especially so after switching from efavirenz or tenofovir disoproxil fumarate (TDF), the older formulation of tenofovir. This suggests that some older antiretrovirals may have a weight-suppressive effect, which may be as important, or more important, than the weight-gain effect of new medications.
Most weight gain was modest (an extra 2kg over two years, compared to an extra 0.5kg in people who didn’t change treatment), with most of the weight gained in the first year.
Reactions to hepatitis C
Gay and bisexual men living with HIV approach the risk of re-infection with hepatitis C after cure in different ways, a Swiss study suggests. The men had all been among the first to receive the highly effective modern hepatitis C treatment in 2016-2017 and had also received advice and counselling to help them avoid catching it again through risky sex or drug use.
Most were surprised by their hepatitis C diagnosis and formed three different groups when processing their diagnoses.
One group were keen to change their sexual behaviour so as to avoid having hepatitis C again. These men had often been living with hepatitis C for several years before the new, more effective medications became available. They greatly appreciated the counselling they received, as one man explained:
“The light went on for me. In the sense of just thinking before you do something. Before, I didn’t have any knowledge of where you can get hepatitis C. You simply go too far and now you say to yourself: I won’t let it go so far again.”
The second group aimed to minimise their risk but differed from the first group as they did not believe they were able to avoid risk completely. They did not view consistent condom use as a realistic option, but considered ‘feasible’ changes like using gloves for fisting, not sharing sex toys and decreasing the number of sexual encounters. One man told an interviewer:
“I’d rather have, for example, one encounter less and with that have the risk only once instead of twice. Rather that than… use a rubber and then not have any fun anymore.”
The third group accepted the risks that accompanied their sexual behaviour as they viewed behaviour change as requiring considerable effort, whereas they perceived medical treatment as an easier option. They accepted – and even expected – multiple rounds of treatment or possibly living with hepatitis C for many years. However, they were concerned about disclosure and the possibility of sexual rejection:
“It’s hard to change much. Because in the moment you don’t want to talk about it. Because that’s when you want to party, have sex, you want to enjoy and you don’t want to say, ‘Hey stop! Hepatitis C!’ Then everything would be over.”
Find out more about how hepatitis C is passed on during sex in our leaflet, below.
How hepatitis C is passed on during sex
We've updated our easy-to read and illustrated information page for gay men living with HIV, giving basic information on how hepatitis C is passed on during sex.
Hepatitis C can be passed on during sex that could lead to contact with semen, rectal mucus or blood. Many gay men with HIV have picked up hepatitis C during sex. Some HIV-negative men have got it too.
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