Non-linear relationships between inflammatory indices and erectile dysfunction in a group of young men living with...

Erectile dysfunction (ED) is a prevalent but underrecognized condition in young men living with HIV (yMLWH). Despite evidence linking inflammation and endothelial dysfunction to ED in the general population, little is known about these associations in yMLWH. This study aims to evaluate the relationship between novel inflammatory indices and ED in yMLWH.

This cross-sectional single-center study included yMLWH aged 18-50 years attending the HIV outpatient clinic at ASST Spedali Civili di Brescia, Italy, between January 2023 and January 2024. ED was assessed by self-report during routine clinical visits. Associations between inflammatory indices and ED were explored using generalized additive (GAM) and generalized linear models (GLM). Among 308 participants, 63 (20.5%) reported ED. Demographic characteristics and viro-immunological parameters were comparable between participants with and without ED; however, individuals with ED showed a higher prevalence of ≥ 3 comorbid conditions (12% vs. 7%), particularly cardiovascular disease (p = 0.018), dyslipidaemia (p < 0.001), and hepatic steatosis (p < 0.001).No significant differences were observed in inflammatory or atherogenic indices between participants with and without ED. Neither univariate nor multivariate models identified significant associations between indices and ED. Although GAMs revealed mildly nonlinear trends for atherogenic index of plasma (AIP), platelet-to-lymphocyte ratio (PLR), and platelet-to-neutrophil ratio (PNR), none reached statistical significance, though model fit was better than for linear models.

In contrast to findings in the general population, no significant associations were observed between ED and inflammation-based indices in our cohort, potentially reflecting HIV-specific mechanisms or age-related differences in index expression. These results support the relevance of non-inflammatory contributors to ED in yMLWH and emphasize the need for multidisciplinary assessment.