HIV Digest	HIV Digest Archive

Protease inhibitor (PI)-based combination antiretroviral therapy has been associated with metabolic and endocrinologic adverse effects that were not apparent during pre-marketing clinical trials, such as hyperlipidemia, insulin resistance, and body fat redistribution. More recently, preliminary reports have suggested an increased incidence of sexual dysfunction among men treated with PIs. Researchers conducted a retrospective cohort study of 254 HIV-positive male PI recipients who received care from the staff-model division of a large New England HMO between 1993 and 1998 to investigate the potential association.

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Screening the full-text electronic medical record for mentions of erectile dysfunction and loss of libido using a text-string search identified cases of sexual dysfunction. Physician abstracters reviewed encounters identified by the search, and cases were considered confirmed if the patient described erectile dysfunction or loss of libido during the visit. CD4+ lymphocyte count, and serum HIV-1 RNA levels, serum total testosterone, free testosterone, luteinizing hormone, prolactin, and thyroid stimulating hormone (TSH or thyrotropin) were obtained from the HMO computerized laboratory database.

A total of 80 incident cases of sexual dysfunction were observed. The unadjusted rate of sexual dysfunction was elevated during any PI therapy. Relative to unexposed individuals, the rate of sexual dysfunction adjusted for confounding was most elevated with use of ritonavir, followed by indinavir, nelfinavir and saquinavir. The unadjusted association of sexual dysfunction with 3TC was significant, but slightly attenuated after adjusting for PI use and other possible confounding factors.

PI-based combination regimens for HIV came into widespread use in 1996. Because studies conducted before the PI era suggested that the incidence of sexual dysfunction increased with stage of HIV disease, a decline among patients treated with effective therapy was expected. However, preliminary reports have suggested the opposite.

Editor's Note: from the Journal of Acquired Immune Deficiency Syndromes