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

Sexual Medicine - Tập 10 - Trang 100542 - 2022
Marco De Tubino Scanavino1,2,3, Emi Mori2, Vera Vichr Nisida1, Vivian I. Avelino-Silva4, Maria Luiza Sant'ana do Amaral1, Bruna Messina1, Aluisio Cotrim Segurado4
1Excessive Sexual Drive and Prevention of Negative Outcome Associated to Sexual Behavior Outpatient Unit, Institute of Psychiatry (IPq), Hospital das Clinicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
2Department of Psychiatry, Institute of Psychiatry (IPq), Hospital das Clinicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
3Experimental Pathophysiology Post-Graduation Program. Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
4Department of Infectious and Parasitic Diseases, Hospital das Clinicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil

Tóm tắt

AbstractIntroductionSexuality 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.AimTo 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).MethodsBetween 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 MeasuresProportion 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.Results70% 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.ConclusionPLHIV in long-term treatment with ART presented alarming rates of depression/anxiety which in turn is correlated with sexual and physical health problems.

Tài liệu tham khảo

Huntingdon, 2020, Factors associated with general sexual functioning and sexual satisfaction among people living with HIV: a systematic review, J Sex Res, 57, 824, 10.1080/00224499.2019.1689379 Santi, 2014, Male sexual dysfunction and HIV-a clinical perspective, Nat Rev Urol, 11, 99, 10.1038/nrurol.2013.314 Huntingdon, 2020, A new grounded theory model of sexual adjustment to HIV: facilitators of sexual adjustment and recommendations for clinical practice, BMC Infec Dis, 20, 1, 10.1186/S12879-019-4727-3/FIGURES/1 Wang, 2013, The prevalence of erectile dysfunction and its association with antiretroviral therapy in HIV-infected men: the Swiss HIV cohort study, Antivir Ther, 18, 337, 10.3851/IMP2372 Agaba, 2017, Sexual dysfunction and its determinants among women infected with HIV, Int J Gynecol Obstetr, 137, 301, 10.1002/IJGO.12140 Sandfort, 2012, Addressing sexual problems in HIV primary care: experiences from patients, Arch Sex Behav, 42, 1357, 10.1007/S10508-012-0009-5 Cove, 2004, Factors associated with sexual problems in HIV-positive gay men, Int J STD and AIDS, 15, 732, 10.1258/0956462042395221 Dijkstra, 2018, HIV-1 status is independently associated with decreased erectile function among middle-aged MSM in the era of combination antiretroviral therapy, AIDS, 32, 1137, 10.1097/QAD.0000000000001800 Hart, 2015, Depression and sexual dysfunction among HIV-positive and HIV- negative men who have sex with men: mediation by use of antidepressants and recreational stimulants, Arch Sex Behav., 44, 399, 10.1007/s10508-014-0279-1 Erdbeer, 2014, Everything fine so far? Physical and mental health in HIV-infected patients with virological success and long-term exposure to antiretroviral therapy, J Int AIDS Soc, 17, 19673, 10.7448/ias.17.4.19673 Asboe, 2007, Sexual dysfunction in HIV-positive men is multi-factorial: a study of prevalence and associated factors, AIDS Care, 19, 955, 10.1080/09540120701209847 Crum-Cianflone, 2007, Erectile dysfunction and hypogonadism among men with HIV, AIDS Patient Care STDs, 21, 9, 10.1089/apc.2006.0071 Moreno-Pérez, 2010, Risk factors for sexual and erectile dysfunction in hiv-infected men: the role of protease inhibitors, AIDS, 24, 255, 10.1097/QAD.0b013e328334444b Amorim, 2000, Mini international neuropsychiatric interview (MINI): validação de entrevista breve para diagnóstico de transtornos mentais, Revista Brasileira de Psiquiatria, 22, 106, 10.1590/s1516-44462000000300003 Gomes-oliveira, 2012, Revista brasileira de psiquiatria psychiatry validation of the brazilian portuguese version of the beck depression inventory-II in a community sample, Braz J Psychiatry, 34, 389, 10.1016/j.rbp.2012.03.005 Rosen, 1997, The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction, Urology, 49, 822, 10.1016/S0090-4295(97)00238-0 Coyne, 2010, The international index of erectile function: development of an adapted tool for use in HIV-positive men who have sex with men, J Sex Med, 7, 769, 10.1111/j.1743-6109.2009.01579.x Althof, 2006, Development and validation of a new questionnaire to assess sexual satisfaction, control, and distress associated with premature ejaculation, J Sex Med, 3, 465, 10.1111/j.1743-6109.2006.00239.x Finotelli Júnior, 2012, Tradução e adaptação cultural do index of premature ejaculation (IPE) para o português do Brasil, Psico-USF, 17, 467, 10.1590/S1413-82712012000300013 Rosen, 2000, The female sexual function index (Fsfi): a multidimensional self-report instrument for the assessment of female sexual function, J Sex Marital Ther, 26, 191, 10.1080/009262300278597 Thiel, 2008, Tradução para Português, adaptação cultural e validação do Female Sexual Function Index, Revista Brasileira de Ginecologia e Obstetricia, 30, 504, 10.1590/S0100-72032008001000005 Gerstenberger, 2010, Sexual desire and the female sexual function index (FSFI): a sexual desire cutpoint for clinical interpretation of the FSFI in women with and without hypoactive sexual desire disorder, J Sex Med, 7, 3096, 10.1111/J.1743-6109.2010.01871.X Guaraldi, 2007, Sexual dysfunction in HIV-infected men: role of antiretroviral therapy, hypogonadism and lipodystrophy, Antivir Ther, 12, 1059, 10.1177/135965350701200713 Zona, 2012, Erectile dysfunction is more common in young to middle-aged HIV-infected men than in HIV-uninfected men, J Sex Med, 9, 1923, 10.1111/j.1743-6109.2012.02750.x Romero-Velez, 2014, Erectile dysfunction among hiv patients undergoing highly active antiretroviral therapy: dyslipidemia as a main risk factor, Sex Med, 2, 24, 10.1002/sm2.25 Vansintejan, 2013, The gay men sex studies: prevalence of sexual dysfunctions in belgian HIV+ gay men, HIV AIDS, 5, 89, 10.2147/HIV.S43962 Shindel, 2012, Erectile dysfunction and premature ejaculation in men who have sex with men, J Sex Med, 9, 576, 10.1111/j.1743-6109.2011.02585.x Luzi, 2009, Body image is a major determinant of sexual dysfunction in stable HIV-infected women, Antivir Ther, 14, 85, 10.1177/135965350901400106 Pinzone, 2015, Self-reported sexual dysfunction in HIV-positive subjects: a cross-sectional study, Infect Dis Trop Med, 1, 1 Organization WH., 2017, Consolidated guideline on sexual and reproductive health and rights of women living with HIV Johannes, 2000, Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study, J Urol, 163, 460, 10.1016/S0022-5347(05)67900-1 Mccabe, 2016, Risk factors for sexual dysfunction among women and men : a consensus statement from the fourth international consultation on sexual medicine 2015, J Sex Med, 13, 153, 10.1016/j.jsxm.2015.12.015 Rooney, 2019, Depression and aging with HIV: associations with health-related quality of life and positive psychological factors, J Affect Disord, 251, 1, 10.1016/j.jad.2019.03.025 Wang, 2018, Prevalence of depression or depressive symptoms among people living with HIV/AIDS in China: a systematic review and meta-analysis, BMC Psychiat, 18, 1, 10.1186/s12888-018-1741-8 Silveira, 2012, Revista Brasileira de Psiquiatria depressive symptoms in HIV-infected patients treated with highly active antiretroviral therapy, 162 Lachâtre, 2017, HIV and hypogonadism: a new challenge for young-aged and middle-aged men on effective antiretroviral therapy, AIDS, 31, 451, 10.1097/QAD.0000000000001348 Rochira, 2014, Hypogonadism in the HIV-infected man, Endocrinol Metab Clin North Am, 43, 709, 10.1016/j.ecl.2014.06.005 Corona, 2014, Low prolactin is associated with sexual dysfunction and psychological or metabolic disturbances in middle-aged and elderly men: the european male aging study (EMAS), J Sex Med, 11, 240, 10.1111/jsm.12327 Conron, 2010, A population-based study of sexual orientation identity and gender differences in adult health, Am J Public Health, 100, 1953, 10.2105/AJPH.2009.174169 Safren, 2011, Promoting the sexual health of MSM in the context of comorbid mental health problems, AIDS Behav, 15, 30, 10.1007/s10461-011-9898-x Shindel, 2011, Sexual dysfunction, HIV, and AIDS in men who have sex with men, AIDS Patient Care STDs, 25, 341, 10.1089/apc.2011.0059 Parsons, 2015, Syndemic production and sexual compulsivity/hypersexuality in highly sexually active gay and bisexual men: further evidence for a three group conceptualization, Arch Sex Behav, 44, 1903, 10.1007/s10508-015-0574-5 Mao, 2009, Self-reported sexual difficulties and their association with depression and other factors among gay men attending high HIV-caseload general practices in Australia, J Sex Med, 6, 1378, 10.1111/j.1743-6109.2008.01160.x Schuster, 2012, The influence of depression on the progression of HIV: direct and indirect effects, Behav Modif, 36, 123, 10.1177/0145445511425231 Nandam, 2020, Cortisol and major depressive disorder—translating findings from humans to animal models and back, Front Psychiat, 10, 1, 10.3389/fpsyt.2019.00974 Seth, 2009, Psychological distress as a correlate of a biologically confirmed STI, risky sexual practices, self-efficacy and communication with male sex partners in African-American female adolescents, Psychol Health Med, 14, 291, 10.1080/13548500902730119
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Sexual Medicine

Tập 10

100542

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