While prevalence of ED in men in the general population has varied from 2-70% in many reports, most studies have examined men older than 40 years of age; few studies have examined ED in younger men. A recent trial hypothesized that both HIV and antiretroviral therapy may be pathogenetically linked to ED.
A cross-sectional, observational, controlled study of 444 HIV-positive and 71 HIV-negative Italian men used the IIEF-5 questionnaire to assess degree of ED. All degrees of ED were higher in the HIV-positive group, with an odds ratio greater than 34. HIV infection was the strongest predictor of ED, to a greater degree than hypogonadism. Desire was the only measured parameter on the IIEF-15 that was not confirmed as an independent risk predictor of HIV-related ED, yet this characteristic is also closely associated with hypogonadism and various psychological factors, thus making this factor more challenging to accurately assess.
This study is the first to highlight a clear association between HIV-positive status and ED, after adjusting for both age and BMI. One possible confounder was that the HIV-negative group was significantly younger than the HIV-positive group. A limitation of the study was that the authors did not identify anti-retroviral therapy exposure associated with ED, and the immunologic status of the HIV-negative group was unknown.
Importantly, this trial demonstrated an increased prevalence of ED in HIV-infected men, thought to be intrinsic to the clinical presentation of HIV. The authors posit that HIV should be added to the list of chronic medical conditions that contribute to ED.
Reference: Zona S, Guaraldi G, Luzi K, et al. Erectile dysfunction is more common in young to middle-aged HIV-infected men than in HIV-uninfected men. J Sex Med 2012;9:1923-1930.