Predictors of Sexual Dysfunction in Patients With HIV on Long-Term Antiretroviral Therapy

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Researchers assessed factors associated with sexual dysfunction among patients with HIV infection receiving long-term antiretroviral therapy.

Symptoms of depression and anxiety were found to be associated with significantly increased rates of sexual dysfunction among men who have sex with men (MSM), heterosexual men, and women with HIV infection receiving long-term antiretroviral therapy (ART), according to results of a cross-sectional observational study published in Sexual Medicine.

In this study, researchers enrolled adult patients with HIV infection from an HIV outpatient care center between September 2013 and October 2016. Patients were asked to complete a questionnaire comprising a sociodemographic interview, a clinical and psychiatric evaluation, and a sexual dysfunction assessment. The sexual dysfunction assessment evaluated patients for erectile dysfunction (ED), premature ejaculation (PE), female sexual dysfunction (FSD), and hypoactive desire. A univariate analysis was performed to assess the association between patients’ demographic and clinical characteristics with each of the sexual dysfunction domains. A multivariate logistic regression analysis was then performed to assess clinically relevant variables associated with any type of sexual dysfunction.

There were 234 patients with HIV infection included in the analysis, of whom 58 were heterosexual men, 113 were MSM, and 63 were women. Among heterosexual men and MSM, the median age was 51.4 and 49.4 years, 59% and 65% were White, and the median duration of ART was 192 (IQR, 79.1-235.2) and 192 (IQR, 106.8-220.2) months, respectively. Among women, the median age was 48.5 years, 44% were White, and the median duration of ART was 201.6 (IQR, 130.8-229.2) months.

In the univariate analysis, the rates of ED and PE in heterosexual men were increased among those who were unemployed vs employed (ED, 76% vs 26%; PE, 33.3% vs 5.5%). Further analysis among heterosexual men showed that a decreased duration of ART was associated with a decreased ED rate, with a median ART duration of 82.2 (IQR, 38.4-226.79) and 216 (IQR, 171.6-241.2) months among those who tested positive vs negative for ED, respectively. In addition, the median Beck Anxiety Inventory (BAI) score was increased among heterosexual men who tested positive vs negative for PE (15 [IQR, 4-23] vs 3 [IQR, 1-10]).

For women, hypoactive desire was more common among those who were unemployed vs employed (60% vs 39%), and FSD was more common among those who were single vs those who were in a stable union (60% vs 40%).

Among all patients, symptoms of depression were more likely among those with self-reported sexual dysfunction. Of heterosexual men, the median Beck Depression Index II (BDI) score was increased among those with vs without ED (7 [IQR, 2-16] vs 2 [IQR, 0-9]; P =.042), as well as those with vs without PE (16 [IQR, 10-32] vs 3 [IQR, 1-9]; P =.006). Similar results were noted in MSM, with median BDI scores increased among those with vs without PE (8 [IQR, 4-16.5] vs 5 [IQR, 2-12]). Of women, median BDI scores were increased among those with vs without hypoactive desire (11.5 [IQR, 7.5-22.5] vs 6.5 [IQR, 4-11]; P =.012).

Multivariable logistic regression showed that MSM status (odds ratio [OR], 2.278; 95% CI, 1.034-5.017; P =.041) and symptoms of depression and anxiety (OR, 2.968; 95% CI, 1.498-5.877; P =.002) were significant predictors for testing positive for sexual dysfunction.

This study was limited by its single-center design and the inability to assess reproductive hormone levels among the entire patient cohort.

“An important implication [of these findings is] for clinicians to specifically evaluate [patients with HIV infection for] symptoms of depression and anxiety, as there is an overlap between these symptoms and HIV infection manifestations,” the researchers concluded.


Scanavino MT, Mori E, Nisida VV, et al. Sexual dysfunctions among people living with HIV with long-term treatment with antiretroviral therapy. Sex Med. Published online July 20, 2022. doi:10.1016/j.esxm.2022.100542