Sexual Dysfunction in the Highly Active Antiretroviral Therapy Era

The possible relationship between HAART and the development of sexual disturbances of HIV-infectedpatients remains yet unresolved because of the inconsistency of the results of the different studies.To analyze the current knowledge on this topic, MEDLINE files were searched for articles dealingwith any manifestation of sexual dysfunction in the HAART era. Selected references from these articlesas well as communications to the main HIV meetings were also reviewed. Sexual dysfunctionseems to be a very common event after the introduction of HAART. The average prevalences ofsexual dysfunction among the different studies was 51%, erectile dysfunction 46%, decreased libido44%, ejaculatory disturbances 39% and orgasmic disorders 27%. These disturbances seemed to bemore common in patients treated with protease inhibitors. Several relevant questions related tosexual dysfunction in these patients are addressed in this review, including the possible pathogenicmechanisms involved. Despite the inconsistent results among the studies, the data that support adirect or indirect role of HAART in the generation of these disturbances seem to exceed the data thatdo not support it. As a conclusion, antiretroviral therapy, particularly protease inhibitors, seems tobe to some extent directly or indirectly related to sexual dysfunction through different mechanisms.