Male Sexual Dysfunction Among Egyptian Patients with Chronic Hepatitis C Virus Infection Before and After Direct-Acting Antiviral Drugs

Abstract

Background Chronic hepatitis C virus (HCV) infection is a global health burden that affects quality of life, with a negative impact on sexual functioning (SF). Aim To study male sexual dysfunction (MSD) among Egyptian men with chronic HCV infection and the impact of therapy with direct-acting antiviral drugs (DAAs) on their sexual health. Methods The self-administered International Index of Erectile Function (IIEF) questionnaire was completed by 400 sexually active male patients with chronic HCV infection without liver cirrhosis before the initiation of therapy with DAAs and then again at the completion of therapy. We compared these baseline questionnaires with those completed by a similar number of age-matched and socioeconomic status–matched controls. In the patients with HCV infection, we also compared IIEF questionnaires completed before and after DAA therapy. Main Outcome Measure We determined the proportions of patients and controls who were dissatisfied with their sexual life and the impact of clearing HCV infection on MSD and evaluated the impact of DAA therapy on the total IIEF score and scores in all IIEF domains. Results Men with chronic HCV infection before DAA treatment had significantly higher erectile dysfunction (ED) scores compared with controls, and scores increased with age (P < .0001). The average scores in all IIEF domains was significantly lower in the patients compared with controls in all age groups. Men with chronic HCV infection had significantly higher ED scores before cure than after cure (P < .0001). Clinical Implications Given the high prevalence of MSD in patients with chronic HCV infection, and given that curing the HCV virus can improve the MSD associated with HCV infection, it is recommended that sexual quality of life in men with HCV be addressed as part of the evaluation protocol before initiation of DAA treatment and again after cure in an effort to improve this particular aspect of quality of life. Strengths & Limitations This is the first study to report on MSD in the era of DAA therapy in Egyptian men with chronic HCV infection before the development of cirrhosis, with a relatively large study population. The use of a detailed version of the IIEF questionnaire reinforces the validity of our study. Conclusion Chronic HCV infection negatively impacts MSD, affecting all domains of the IIEF, and effects increase with age. The MSD associated with HCV infection is significantly improved in patients who are cleared of the virus. These findings require further confirmation and need to be addressed as part of a comprehensive therapeutic plan to improve patients’ quality of life.

Psychological and Sexual Health During the COVID-19 Pandemic in Egypt: Are Women Suffering More?

“…It is usual that studies addressing sexual function conducted on Egyptian males encounter similar rejection to complete the questionnaires and refusal to openly discuss sexual complaints with the medical personnel. 29,30 In conservative eastern countries, males with sexual dysfunction or a recognizable sexual problem are considered deficient by their partners and acquaintances. Male sexual function is perceived to be equivalent to masculinity and any declared dissatisfaction is believed to threaten this masculine genital pride and male dominance.…”

Improvement of sexuality after hepatitis C cure with direct acting antivirals

“…The potential impact of viral eradication on sexual functioning has been described in few studies. 3,7,9 However, current data are not easy to interpret because of: (i) different target populations (many patients with advanced liver disease), (ii) frequent use of interferon, (iii) use of different measurement scales to assess sexuality and (iv) most of the studies evaluating quality of life (QoL) do not include sexuality as a specific parameter. 10 The current prospective study demonstrates a high prevalence of sexual dysfunction (61.9%) in an homogeneous real-life cohort of HCV patients with mild liver disease, compared to non-HCV population studies.…”

“…In HCVinfected patients, the rate of sexual dysfunction is high, [3][4][5][6] as shown in several case-control studies. [7][8][9][10][11] However, its prevalence varies widely among different studies 3 because of the heterogeneity of patients included and the different methodologies used for sexual assessment.…”

“…9,12 To date, few studies have explored the potential beneficial effect of DAA on sexual life in HCV patients. 7,9 This prospective study aimed at assessing sexuality in a cohort of HCV-infected patients receiving DAA, and to evaluate the impact of viral eradication on this sensitive domain of QoL.…”

“…Effective and safe interferon‐free therapy with direct acting antivirals (DAA) has completely changed the scenario of hepatitis C. Indeed, sustained virologic response (SVR) has shown significant benefits in QoL scores, regardless of the stage of liver disease 9,12 . To date, few studies have explored the potential beneficial effect of DAA on sexual life in HCV patients 7,9 . This prospective study aimed at assessing sexuality in a cohort of HCV‐infected patients receiving DAA, and to evaluate the impact of viral eradication on this sensitive domain of QoL.…”