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Penile vascular status in young men living with HIV experiencing erectile dysfunction: A comparative cross-sectional
Giorgio Tiecco1, Andrea Delbarba2, Cosimo Colangelo1
1Department of Clinical and Experimental Sciences, SD of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, Brescia, Italy.
Insights
Erectile dysfunction in men with HIV is linked to early penile vascular changes, as shown by Doppler echography. This suggests routine screening for vascular health in these patients.
Area of Science:
- Vascular Medicine
- Infectious Diseases
- Urology
Background:
- Erectile dysfunction (ED) in people living with HIV (PLWH) is multifactorial, with penile vascular status often underexplored.
- Dynamic penile color Doppler echography (DP-CDE) is a key tool for assessing penile vascularity.
Purpose of the Study:
- To assess penile vascular status in young males living with HIV who have ED.
- To compare vascular parameters between PLWH and HIV-negative controls.
Main Methods:
- A monocentric, comparative cross-sectional study involving young males with HIV (18-50 years) on antiretroviral therapy and HIV-negative controls with ED.
- DP-CDE was used to evaluate peak systolic velocity, intima-media thickness, and end-diastolic velocity.
- Statistical analyses included k-means clustering and logistic regression.
Main Results:
- Pathological intima-media thickness was significantly higher in young males with HIV (76%) compared to young controls (49%), but similar to middle-aged controls (76.1%).
- Younger HIV-negative status (OR 0.353) was protective against pathological intima-media thickness, while increasing age was a risk factor (OR 1.09).
- Penile vascular parameters from DP-CDE predicted group membership (PLWH vs. HIV-negative) independently of age.
Conclusions:
- This is the first study using DP-CDE to evaluate ED in young males with HIV, revealing an association between HIV and early vascular alterations.
- ED in PLWH may indicate underlying penile vascular disease, warranting further vascular screening.
- Routine sexual health evaluations and early vascular screening are recommended for PLWH presenting with ED.
Background:
Erectile dysfunction in people living with HIV is a multifactorial disease, but the role of penile vascular status assessed by dynamic penile color Doppler echography is underexplored.
Objectives:
This study assessed penile vascular status in young males living with HIV experiencing erectile dysfunction, comparing them to HIV-negative controls stratified into young (<50 years) and middle-aged (51-60 years).
Materials And Methods:
This monocentric, comparative cross-sectional study included young males living with HIV (18-50 years) on antiretroviral therapy for >12 months and HIV-negative individuals presenting with erectile dysfunction. We used dynamic penile color Doppler echography to evaluate penile vascular parameters such as peak systolic velocity, intima-media thickness, and end-diastolic velocity. Statistical analyses, including k-means clustering and stepwise multivariate logistic regression, assessed associations between clinical variables and vascular parameters.
Results:
Of 310 young males living with HIV screened, 50 (16.1%) reported erectile dysfunction and were enrolled, with 97 HIV-negative individuals included as controls. Pathological intima-media thickness was significantly higher (p = 0.004) in young males living with HIV (76%) than in young controls (49%) but comparable to middle-aged controls (76.1%). Stepwise multivariate logistic regression identified belonging to the young control group, compared to young males living with HIV, as a protective factor against pathological intima-media thickness (OR 0.353, 95% CI 0.138-0.902, p = 0.0295), while increasing age was a significant risk factor (OR 1.09, 95% CI 1.01-1.18, p = 0.0247). Relative inhomogeneity of clusters was tested demonstrating that membership in either the people living with HIV or HIV-negative group was a significant predictor of cluster assignment based on dynamic penile color Doppler echography parameters, independent of age (p = 0.0025).
Discussion And Conclusions:
This study is the first to utilize dynamic penile color Doppler echography to evaluate erectile dysfunction in young males living with HIV, highlighting the association between HIV and early vascular alterations. Clinicians should incorporate routine sexual health evaluations into routinary out-patients visits, using erectile dysfunction as a potential indicator for further vascular screening and early intervention.
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