Gonadal and sexual function in men living with HIV: insights from a single-centre study

The study aimed to estimate the prevalence of hypogonadism and erectile dysfunction (ED) in male living with the human immunodeficiency virus (HIV), MLWH, and to explore associations between HIV-related variables and gonadal/sexual function.

From 2019 to 2024, gonadal and sexual function were evaluated in consecutively enrolled MLWH through hormonal assessments and IIEF-15 questionnaire. Anthropometrics and HIV-related parameters, including type of Highly Active Anti-Retroviral Therapy, HAART, were also evaluated.

Among 60 MLWH, 70.0% presented with ED. Hypogonadism was observed in 18.3%, primarily hypogonadotropic (72.7%). Although both eu- and hypogonadal MLWH presented pathological IIEF-15 scores, no differences in the five domains of IIEF-15 were found. Hypogonadal MLWH had significantly higher BMI (p = 0.046) and greater smoking prevalence (p = 0.002), and lower 17β-estradiol levels (p = 0.017). In the whole cohort, total testosterone was negatively correlated to BMI (r=-0.595, p = 0.001) and waist circumference (r=-0.656, p = 0.011), and positively to 17β-estradiol (r = 0.457, p = 0.006) and SHBG (r = 0.325, p = 0.033). Calculated free testosterone also negatively correlated with BMI (r=-0.519, p = 0.023) and WC (r=-0.719, p = 0.019). Considering HAART, ED was more prevalent among those using Integrase Strand Transfer Inhibitor (p = 0.017). Conversely, MLWH treated with Proteinase Inhibitors showed higher total testosterone, SHBG and 17β-estradiol levels (respectively, p = 0.018, p = 0.015 and p = 0.020), despite no differences in calculated free testosterone or prevalence of ED.

ED is highly prevalent multifactorial disorder in MLWH. Decreased serum testosterone levels, which are also related to increased visceral fat accumulation, are not the only driver of its onset. HIV-related factors, such as HAART, also appear to have an impact on gonadal and sexual function. A multidisciplinary approach, integrating infectious disease and sexual medicine expertise, is essential for optimal care.