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

IF 3.5 2区医学 Q1 Medicine

Journal of Endocrinological Investigation Pub Date : 2025-09-22 DOI:10.1007/s40618-025-02683-5

Ilaria Bonaventura, Valeria Hasenmajer, Nicolò F D'Addario, Carlotta Pozza, Giancarlo Ceccarelli, Gabriella d'Ettorre, Claudio M Mastroianni, Emmanuele A Jannini, Daniele Gianfrilli

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引用次数: 0

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

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男性艾滋病毒感染者的性腺和性功能：来自单中心研究的见解。

目的：本研究旨在估计男性人类免疫缺陷病毒（HIV）感染者性腺功能减退和勃起功能障碍（ED）的患病率，并探讨HIV相关变量与性腺/性功能之间的关系。方法：2019 - 2024年，通过激素评估和IIEF-15问卷对连续入组的产妇进行性腺和性功能评估。人体测量学和艾滋病毒相关参数，包括高活性抗逆转录病毒疗法（HAART）的类型也进行了评估。结果：60例MLWH中，70.0%出现ED， 18.3%出现性腺功能减退，以促性腺功能减退为主（72.7%）。虽然eu-和性腺功能低下的MLWH均呈现病理性IIEF-15评分，但IIEF-15的5个域没有发现差异。性腺功能低下的MLWH有较高的BMI （p = 0.046）、较高的吸烟率（p = 0.002）和较低的17β-雌二醇水平（p = 0.017）。在整个队列中，总睾酮与BMI （r=-0.595, p = 0.001）、腰围（r=-0.656, p = 0.011）呈负相关，与17β-雌二醇（r= 0.457, p = 0.006）、SHBG （r= 0.325, p = 0.033）呈正相关。计算的游离睾酮与BMI （r=-0.519, p = 0.023）和WC （r=-0.719, p = 0.019）呈负相关。考虑HAART治疗，使用整合酶链转移抑制剂的患者中ED更为普遍（p = 0.017）。相反，用蛋白酶抑制剂治疗的MLWH显示出更高的总睾酮、SHBG和17β-雌二醇水平（分别为p = 0.018、p = 0.015和p = 0.020），尽管计算的游离睾酮和ED患病率没有差异。结论：ED在MLWH中是高度普遍的多因素疾病。血清睾酮水平下降也与内脏脂肪堆积增加有关，但这并不是其发病的唯一驱动因素。艾滋病毒相关因素，如HAART，似乎也对性腺和性功能有影响。综合传染病和性医学专业知识的多学科方法对最佳护理至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Endocrinological Investigation ENDOCRINOLOGY & METABOLISM-

CiteScore

8.10

自引率

7.40%

发文量

242

期刊介绍： The Journal of Endocrinological Investigation is a well-established, e-only endocrine journal founded 36 years ago in 1978. It is the official journal of the Italian Society of Endocrinology (SIE), established in 1964. Other Italian societies in the endocrinology and metabolism field are affiliated to the journal: Italian Society of Andrology and Sexual Medicine, Italian Society of Obesity, Italian Society of Pediatric Endocrinology and Diabetology, Clinical Endocrinologists’ Association, Thyroid Association, Endocrine Surgical Units Association, Italian Society of Pharmacology.