Majority of gay men on HAART have sexual problems but PIs may not be to blame

Over 70% of gay and bisexual men treated with HAART have experienced some form of sexual dysfunction, according to a French study published in the June 2002 edition of Journal of Acquired Immune Deficiency Syndromes. The study noted, however, that protease inhibitors were no more likely to cause sexual problems than other classes of anti-HIV drugs.

In the study, a total of 156 gay and bisexual men completed a two-part 163 item questionnaire, with questions about erectile function, orgasms, sexual desire, intercourse satisfaction and overall satisfaction. The questionnaire also included a sexual functioning inventory which inquired about psychological symptoms, body image, sexual satisfaction and global sexual satisfaction.

The men participating in the study were divided into three groups, according to their HIV treatment history. Group A, included 91 patients who had been receiving a HAART regimen containing a protease inhibitor for over a month; group B, included 23 people who had never been treated with a protease inhibitor; and group C contained 42 people who had stopped taking a protease inhibitor more than a month before. The average age of the study participants was a little over 40 years and the average CD4 count was 415 cells/mm3.

Overall 111 (71%) of the group reported some form of sexual dysfunction (65 of 91 in group A, 15 of 23 in group B and 31 of 42 in group C). Loss of sexual desire was most frequently reported (99 of the 111, or 89% of those reporting sexual problems), followed by erectile dysfunction (96 of 111 or 86%). Problems with orgasm were reported by 76 people and with ejaculation by 65 patients. Over half of those reporting loss of libido or problems obtaining or maintaining an erection said it was severe or very severe.

A history of sexual problems before being diagnosed HIV-positive was reported by 18% of the study group and a little over 32% said that they had experienced sexual dysfunction in the period between their HIV diagnosis and starting treatment with HAART. In addition, 10 of the study sample had a history of high-blood pressure, heart disease or diabetes, all of which are associated with male sexual dysfunction.

Sexual problems appeared to be having a negative impact on quality of life with over two thirds (66.7%) reporting that their problems had existed for over six months and 66% reported that they found their sexual difficulties difficult or very difficult to accept.

Although previous studies have found that protease inhibitors are strongly linked with sexual dysfunction, the French investigators found no difference in the prevalence of sexual dysfunction according to whether the HAART regimen contained a protease inhibitor. The invetsigators attribute this to having a homogenous study group.

Those reporting sexual problems were significantly more likely to have indicated on their questionnaire that they were suffering from anxiety or depression. The study authors note that ‘HAART regimens are well known for their adverse effects’ and suggest that ‘if sexual dysfunction is indeed caused by HAART or even if patients simply attribute sexual dysfunction to HAART, it may lead to poorer treatment adherence.’

The study does raise questions about the association between sexual dysfunction and HAART, not least because it does not specify the duration of treatment in the study population.

The importance of understanding sexual problems in people taking HAART is emphasised in the study’s conclusion which notes that the majority of people taking HAART experienced sexual problems and that over two-thirds found this difficult or very difficult to accept, adding: ‘given the increased life expectancy of HIV-infected patients since the advent of HAART, their sexuality should no longer be considered only in terms of the prevention of transmission. Sexual dysfunction in these patients should be specifically diagnosed and treated as in patients with other chronic diseases.’