Sexual Dysfunctions Among People Living with HIV With Long-Term Treatment with Antiretroviral Therapy

Abstract

Abstract Introduction Sexuality plays an essential role in the psychosocial well-being of people living with HIV (PLHIV) but it is still less assessed by healthcare professionals during treatment. Aim To investigate the frequency of those screening positive for sexual dysfunction (SD) and associated factors according to gender/sexual orientation in PLHIV under long-term treatment with antiretroviral therapy (ART). Methods Between September 2013 and October 2016, 234 PLHIV adults in treatment in São Paulo were included. Participants were sexually active, did not present sexual orientation disorder or body dysmorphic disorder, and did not use sexual hormones. We performed clinical interviews and measured levels of depression, anxiety, and levels of sexual hormones. SD was assessed using a self-report questionnaire. Main Outcome Measures Proportion of participants screening positive for SD in the International Index of Erectile Function, the Index of Premature Ejaculation, and the Female Sexual Function Index. In the regression analyses, the outcome SD considered any SD presented with disregard to gender. Results 70% of participants reported consistent adherence to ART and 96% had an undetectable viral load. The median (Md) duration of ART was 198 months (inter quartil range, IQR 111.6–230.4) and the median CD4 was 655 cells/mm3 (IQR 443–871). Screening positive for erectile dysfunction was 49.7%, premature ejaculation 16.9%, female sexual dysfunction 27.4% and hypoactive desire 45.1%. Lower testosterone and prolactin levels were associated with erectile dysfunction in heterosexual men (n = 58); lower levels of oestradiol and higher levels of follicle stimulating hormone were associated with female sexual dysfunction and hypoactive desire in female participants (n = 63). The multivariable model used included comorbidities and hormonal abnormality and found that age (odds ratio, OR = 1.04, 95% confidence interval, 95%CI 1.00–1.08, P = .026) and the presence of depression/anxiety (OR = 2.96; 95%CI 1.52–5.77; P = .001) were associated with SD. Also, men reporting engaging in sex with other men were associated with screening positive for SD (OR 2.66; 95%CI 1.52–5.77, P = .013). During treatment of PLHIV, it is important to evaluate sexual health and symptoms of depression and anxiety specifically. The strength of this study consists in evaluating PLHIV who have been in long-term treatment with ART and analyzing those screening positive for SD and associated factors for each group (heterosexual men, men reporting engaging in sex with other men, and women). Limitation includes the difficulty to generalize the findings of the study, and not exploring women's sexual orientation. Conclusion PLHIV in long-term treatment with ART presented alarming rates of depression/anxiety which in turn is correlated with sexual and physical health problems.