Living with HIV more than doubles the risk of erectile dysfunction in middle-aged MSM

Living with HIV is an independent risk factor for erectile problems among middle-aged men who have sex with men (MSM), Dutch investigators report in the online edition of AIDS. After taking into account all other risk factors, HIV infection was associated with a more than doubling in the risk of erectile dysfunction. 

“This study of MSM aged >45 years found that decreased sexual functioning is more prevalent among HIV-1 infected participants, most of whom were on cART [combination antiretroviral therapy], compared to similar, HIV-uninfected controls,” comment the authors. “HIV-1 status was independently associated with decreased erectile function, and the presence of AANCC [age-associated non-communicable comorbidities], a worse frailty status, and exposure to lopinavir/ritonavir appeared to be independent risk factors.”

Research has already shown that HIV-positive MSM are more likely to report erectile dysfunction than men in the general population. Investigators in Amsterdam wanted to expand understanding of the relationship between infection with HIV and reduced sexual function among MSM.


adjusted odds ratio (AOR)

Comparing one group with another, expresses differences in the odds of something happening. An odds ratio above 1 means something is more likely to happen in the group of interest; an odds ratio below 1 means it is less likely to happen. Similar to ‘relative risk’. 


The presence of one or more additional health conditions at the same time as a primary condition (such as HIV).


Describes a general decline in physical health and a loss of reserves, most often seen in older people. Frailty leads to a person being less robust and less able to bounce back after an adverse event. A person with frailty may move more slowly, have lost some of their physical strength, have less energy and be less mentally agile. 

cross-sectional study

A ‘snapshot’ study in which information is collected on people at one point in time. See also ‘longitudinal’.


A mental health problem causing long-lasting low mood that interferes with everyday life.

They designed a cross-sectional study involving 399 HIV-positive and 366 matched HIV-negative MSM, all of whom were enrolled in an ongoing study of HIV and ageing. The men were aged 45 years and older. Almost all the HIV-positive men were taking antiretrovirals.

At follow-up appointments, participants were asked to report on their sexual function in the previous four weeks: sexual satisfaction; sexual desire; and erectile function. The investigators examined the prevalence of reduced sexual function according to HIV status and also the association between reduced sexual function and infection with HIV, controlling for factors such as depression, frailty, and non-communicable co-morbidities.

HIV-positive MSM were significantly more likely to report decreased sexual satisfaction (18% vs 12%, p = 0.02), decreased sexual desire (7% vs 4%, p = 0.03) and decreased erectile function (13% vs 3%, p < 0.001) than their HIV-negative peers.

After taking into account age and ethnicity, infection with HIV remained independently associated with decreased sexual satisfaction (aOR = 1.64; 95% CI, 1.08-2.49) and decreased erectile function (aOR = 4.07; 95% CI, 2.08-7.94).

But after taking into account other risk factors for reduced sexual function, including waist-to-hip ratio, the number of co-morbidities, use of anti-hypertensives and anti-depressants, infection with HIV only remained associated with decreased erectile function (aOR = 2.53; 95% CI, 1.23-5.20).

The authors then examined which HIV-related factors were associated with reduced erectile function.

In their first analysis, a low CD4 cell count, time since HIV diagnosis and a past AIDS diagnosis emerged as possible risk factors. But all significant associations disappeared after taking into account co-morbidities and frailty. However, there was a significant relationship between erectile dysfunction and treatment with the protease inhibitor lopinavir/ritonavir. Both current use of the drug (aOR = 5.39; 95% CI, 2.09-13.92) and cumulative exposure to lopinavir/ritonavir (aOR = 1.20; 95% CI, 1.07-1.35) increased the risk of erectile problems.

“Our findings suggest that assessment of sexual function should be included in standard clinical care,” conclude the researchers. “If targeted interventions addressing specific risk factors for decreased sexual functioning can be developed, quality of life of HIV-1-infected MSM may be improved. Moreover, detection and treatment of possible sexual problems in MSM, in general, might contribute to more effective preventive behaviour as several studies have found more unprotected sexual contact in men reporting ED [erectile dysfunction].”


Dijkstra M et al. HIV-1 status is independently associated with decreased erectile function among middle-aged men who save sex with men in the era of cART. AIDS, online edition. DOI: 10.1097/QAD.0000000000001800 (2018).