Sexual dysfunction in HIV infection

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Correspondence

Sexual dysfunction in HIV infection

The Lancet 2007; 369:905-906

DOI:10.1016/S0140-6736(07)60446-2

Paola Trotta a, Ammassari a, Rita Murri b,

Antonella d'Arminio Monforte c and Antinori a

We welcome Rosemary Basson and The Lancet's proposal that sexuality

in chronic illness should no longer be ignored (Feb 3, p 350).1

Particularly, we would like to focus on sexual dysfunction among

people with HIV infection. In this context several factors could

contribute to sexual dysfunction: psychological and emotional issues,

endocrine alterations, peripheral and autonomic neuropathy,

comorbidity such as cardiovascular diseases or sexually transmitted

diseases, and side-effects of antiretroviral therapy or other

concomitant medications.

Little scientific attention has been dedicated to this topic and

clinical investigation is often intuitively based, clinicians

commonly being reluctant to assess sex-related issues with their

patients for many reasons including fear of awkward situations, lack

of training about sex-related counselling, and time constraints.

Furthermore, HIV-infected patients are not always inclined to

disclose problems of sexual activity because of the specific

relevance of sex-related issues to this infection.

Undisclosed sexual dysfunction among HIV-infected people can have

specific consequences. First, patient-reported sexual dysfunction is

associated with non-adherence to antiretroviral therapy.2 Since non-

adherent patients are more likely to have higher HIV RNA

concentrations in semen or cervical secretions (with the risk of

harbouring drug-resistant virus)3 and to engage in unprotected sex,4

they could cause more frequent transmission of drug-resistant HIV

strains. Second, men with alterations in sexual activity might take

treatment for erectile dysfunction outside of medical prescription,

raising the likelihood of pharmacokinetic interaction with

antiretrovirals.5

In the light of clinicians' need to optimise treatment adherence and

to ensure an adequate quality of life for HIV-infected people,

identification and treatment of sexual dysfunction together with

close risk-reduction counselling should be encouraged, not only for

the sake of the individual but also for the sake of public health.

We declare that we have no conflict of interest.

References

1. Basson RM. Sexuality in chronic illness: no longer ignored. Lancet

2007; 369: 350-352. Full Text | Full-Text PDF (57 KB) | CrossRef

2. Trotta MP, Ammassari A, Cozzi-Lepri A, et al. Adherence to highly

active antiretroviral therapy is better in patients receiving non-

nucleoside reverse transcriptase inhibitor-containing regimens than

in those receiving protease inhibitor-containing regimens. AIDS 2003;

17: 1099-1102. MEDLINE | CrossRef

3. Barroso PF, Schechter M, Gupta P, Bressan C, Bomfim A, on

LH. Adherence to antiretroviral therapy and persistence of HIV RNA in

semen. J Acquir Immune Defic Syndr 2003; 32: 435-440.

4. TE, Barron Y, Cohen M, et al. Adherence to antiretroviral

therapy and its association with sexual behavior in a national sample

of women with human immunodeficiency virus. Clin Infect Dis 2000; 34:

529-534. CrossRef

5. Nandwani R, Gourlay Y. Possible interaction between sildenafil and

HIV combination therapy. Lancet 1999; 353: 840. Full Text | Full-Text

PDF (79 KB) | MEDLINE | CrossRef

Affiliations

a. National Institute for Infectious Diseases " L. Spallanzani " IRCCS,

Via Portuense 292, 00149 Rome, Italy

b. Clinic of Infectious Diseases, Catholic University, Rome, Italy

c. Clinic of Infectious and Tropical Diseases, S Paolo University

Hospital, Milan, Italy