Approximately one-third of HIV-positive men on stable antiretroviral therapy (ART) experience sexual problems, according to a new study in the Journal of Sexual Medicine. 

Such problems may include sexual dysfunction, sexually transmitted infections (STIs), and poor sperm quality, the authors said.

An estimated 38 million people across the globe are HIV-positive, and almost half of them are men. Antiretroviral therapy has improved their quality of life, and some men are interested in starting families. But sexual health is not always addressed or studied in this population.

In the current study, researchers investigated several aspects of sexual health in a group of 87 HIV-positive men on stable ART.

Each man underwent a comprehensive physical exam that included hormone and semen analyses, STI screenings, and a genital tract ultrasound. The men also completed questionnaires about their medical history, sexual function, and any symptoms of hypogonadism and prostatitis.

These assessments were conducted at baseline and at a follow-up appointment 12 months later. During the second evaluation, the men answered questions about any changes in their health.

Baseline Results 

The participants ranged in age from 38 to 49 years. Just over half of them were in a relationship and most were sexually active. They had been HIV-positive for a range of 3 to 10 years and on ART for a range of 2 to 9 years.

Other baseline findings were as follows:

HIV was found in 10% of the blood samples and 11% of the semen samples. Approximately 8% of the participants had bacterial STIs. Sperm count was below the lower 5th percentile for about a quarter of the men. Almost half of the men had sperm morphology parameters below the lower 5th percentile.

Follow-Up Results 

Sexual health results remained “generally stable” through the 12-month study period. Over a quarter were being treated for andrological disorders. Twenty-three men said their libido had decreased over time, while 17 said their libido had improved. Bacterial STIs were reported by 17% of the men.

Also at the follow-up, HIV was found in 16% of the blood samples and 11% of the semen samples.

Seven of the men had started new relationships, and 4 had fathered a child. Two said they would like to have children. Semen parameters were “stable except for pH and elastase” at follow-up, the authors said.

Overall, they determined that approximately one-third of the men had “sexual ill-health.”

“Our study provides evidence that sexual health should be actively taken into account in the routine consultation by infectious disease specialists, and an interdisciplinary approach is desirable in the case of symptoms or signs of sexual ill-health,” they concluded.

Resources

• The Journal of Sexual Medicine - “Sexual Health in HIV-Positive Men Under Stable Antiretroviral Therapy During a 12-Month Period”
  Pilatz, Adrian MD, et al.
  (Full-text. Article in press. Published: January 5, 2021)
  https://www.jsm.jsexmed.org/article/S1743-6095(20)31053-5/fulltext#%20