ED Drugs Linked to STD in HIV-Positive Men

Sep 14, 2013
HIV/AIDS
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DENVER — In HIV-positive men, those who were prescribed erectile dysfunction meds were also more likely to have had syphilis, a researcher reported.

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Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered preliminary until published in a peer-reviewed journal.

In HIV-positive men, those who were prescribed erectile dysfunction meds were also more likely to have had syphilis.

Note that the finding suggests that doctors prescribing drugs for erectile dysfunction to HIV-positive men should at least have a discussion about the need for safer sex.

In a cross-sectional analysis of medical records, 8.7% of men had a history of syphilis and 15% had at least one prescription for an erectile dysfunction drug, according to Nimish Patel, PharmD, of the Albany College of Pharmacy and Health Sciences, in Albany, N.Y.

In a multivariate analysis, using such drugs was the only independent risk factor for a history of syphilis, Patel said here at the annual Interscience Conference on Anti-Microbial Agents and Chemotherapy.

But, he told MedPage Today, the association doesn’t prove that one led to the other. In particular, he said, it was impossible in many cases even to tell if the diagnosis of syphilis came before or after the prescription. Also, it’s possible that the use of erectile dysfunction drugs is a marker for some other risk factor for syphilis.

But the finding suggests that doctors prescribing drugs for erectile dysfunction to HIV-positive men should at least have a discussion about the need for safer sex, Patel said.

The need for help with erection is a “common complaint” among HIV-positive men, especially as they age, commented Jean-Michel Molina, MD, of Saint-Louis Hospital in Paris, who was not involved with the research but who moderated a session at which it was presented.

But it would be interesting to know more about the demographics of the study population, and especially how many are men who have sex with men (MSM), he told MedPage Today.

“Syphilis is really prevalent among MSM and I would suspect most of the cases were seen among MSM,” he said, although Patel’s data did not include the sexual orientation of the patients.

The findings are also a “signal to HIV doctors that we should not care so much about opportunistic infections any more … but we should probably care more about (sexually transmitted diseases) than we did in the past.”

Patel and colleagues studied records of 872 men from a single HIV clinic from 2007 through 2012, hoping to quantify the rate of syphilis and to see if erectile dysfunction drugs are associated with the disease.

All told, 76 men had a history of syphilis and 131 had been given erectile dysfunction drugs, including sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra).

In bivariate analyses, he reported, men getting the drugs were older and had higher rates of hypertension, diabetes, and dyslipidemia, factors that might help account for their erectile problems.

The prevalence of syphilis among men getting the drugs was 13.7%, compared with 7.8% among nonusers, he reported.

In a multivariate analysis, adjusted for age and recreational drug use, those proportions yielded an odds ratio of 1.98 (95% CI 1.11-3.55, P=0.02).

Nimish cautioned that the findings likely underestimate the use of erectile dysfunction drugs, since many men acquire them for recreational use through other means than their HIV care provider. He also noted that there is likely a range of confounding factors that were not measured.

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