Men Living With HIV and Experiencing Sexual Dysfunction: An Analysis of Treatment Options

Abstract

Men living with HIV (MLWH), especially younger MLWH, may experience sexual dysfunction in greater numbers than men without HIV infection. This manuscript describes the prevalence of two major causative factors of sexual dysfunction in MLWH: hypogonadism and erectile dysfunction. A description of assessment and evaluation is presented. Additionally, the evidence for use of pharmacological and herbal therapies is presented with recommendations for treatment. MLWH who exhibit hypogonadism and/or erectile dysfunction should receive similar care to those without HIV infection. There is evidence to support the use of testosterone replacement therapy and phosphodiesterase 5 inhibitors in this population, and there is limited evidence for the use of certain herbs such as yohimbine. The ethics of treating sexual dysfunction for MLWH are discussed. A case study follows as an example of the application of evidence-based treatments recommended for practice.

Prevalence of Hypogonadism and Associated Risk Factors among Newly Diagnosed ART Naïve HIV-Infected Males in Mwanza, Tanzania

“…Te exact cause of hypogonadism in HIV patients is not known, but decreased gonadotropin release from the pituitary is thought to be one of the mechanisms [8]. Hypogonadism can be intensifed by various factors, and in addition, studies have proposed it to have multifactorial causes, including aging [5,9], noninfectious comorbidities (obesity, diabetes, hypertension, cancers, and malnutrition among others) [5,[10][11][12][13], anemia [5,11], common acute and chronic illnesses [14], weight loss [15], invasion of glands by HIV, or other pathogens such as hepatitis virus [16], cigarette smoking, using drugs, such as opiates, megestrol acetate, methadone [5,17], and steroids [18], as well as progression to AIDS stages [19]. Te use of herbal medicines could be one of the contributing factors to hypogonadism.…”

Hypogonadism and Associated Factors in Patients With HIV Infection Based on Total and Free Testosterone

“…The cause of hypogonadism in HIV-positive patients is not clearly known and a number of cofactors can intensify it, in addition, some studies have proposed that hypogonadism has multi-factorial causes, including: aging (5), anemia (6), diabetes (7), malnutrition (8), common acute and chronic illnesses (9), weight loss (10), invasion of glands by HIV, or other pathogens like hepatitis (11), smoking, using drugs, such as opiates, megestrol acetate, methadone (12), and steroids (13), as well as progression to AIDS stages (14). Occasionally hypogonadism may contribute to primary testicular etiology, termed 'primary hypogonadism'.…”