Sexual dysfunction in the highly active antiretroviral therapy era

The possible relationship between HAART and the development of sexual disturbances of HIV-infected patients remains yet unresolved because of the inconsistency of the results of the different studies. To analyze the current knowledge on this topic, MEDLINE files were searched for articles dealing with any manifestation of sexual dysfunction in the HAART era. Selected references from these articles as well as communications to the main HIV meetings were also reviewed. Sexual dysfunction seems to be a very common event after the introduction of HAART. The average prevalences of sexual dysfunction among the different studies was 51%, erectile dysfunction 46%, decreased libido 44%, ejaculatory disturbances 39% and orgasmic disorders 27%. These disturbances seemed to be more common in patients treated with protease inhibitors. Several relevant questions related to sexual dysfunction in these patients are addressed in this review, including the possible pathogenic mechanisms involved. Despite the inconsistent results among the studies, the data that support a direct or indirect role of HAART in the generation of these disturbances seem to exceed the data that do not support it. As a conclusion, antiretroviral therapy, particularly protease inhibitors, seems to be to some extent directly or indirectly related to sexual dysfunction through different mechanisms.