Erectile Dysfunction Is More Common in Young to Middle-Aged HIV-Infected Men than in HIV-Uninfected Men Stefano Zona, MD,* Giovanni Guaraldi, MD,* Kety Luzi, MD,* Mattia Beggi, MD,* † Daniele Santi, MD, ‡ Chiara Stentarelli, MD,* Bruno Madeo, MD, PhD, ‡ and Vincenzo Rochira, MD, PhD ‡ *Metabolic Clinic, Infectious Diseases Unit, Department of Medicine and Medical Specialities, University of Modena and Reggio Emilia, Modena, Italy; † Health Science Research Centre, Department of Life Sciences, Roehampton University, London, UK; ‡ Chair and Unit of Endocrinology & Metabolism, Department of Medicine, Endocrinology & Metabolism, Geriatrics, University of Modena and Reggio Emilia, Azienda AUSL of Modena-NOCSAE of Baggiovara, Modena, Italy DOI: 10.1111/j.1743-6109.2012.02750.x ABSTRACT Introduction. Erectile dysfunction (ED) is common among elderly men and patients suffering from chronic diseases, the latter probably including also HIV infection. No studies, however, compared the prevalence of ED in HIV- infected and HIV-uninfected individuals using the International Index of Erectile Function (IIEF-15). Aim. The aim of this study is to compare ED prevalence in young to middle-aged men with and without HIV infection using the IIEF-15 questionnaire. Methods. We conducted a cross-sectional, observational, controlled study on 444 HIV-infected men and 71 HIV- uninfected men. Main Outcomes Measures. The IIEF-15 questionnaire was used to assess ED. A cutoff score of 25 of the erectile domain was used to diagnose ED. Serum testosterone, demographic, and anthropometric (weight, height, and body mass index [BMI]) characteristics were obtained from all participants. Statistics included the T-test, the Fisher’s test, univariable and multivariable logistic regression, and univariate and multivariate Spearman’s correlation analysis. Results. The HIV-uninfected group was significantly younger than the HIV-infected group and presented a higher BMI (P < 0.001). The prevalence of mild, moderate, and severe ED was higher in HIV-infected men than in HIV-uninfected men of all decades of age. In univariate analysis, HIV infection was associated with ED (odds ratio [OR] = 34.19, P < 0.001). In multivariable logistic regression analysis, HIV infection remained the strongest pre- dictors of ED (OR = 42.26, P < 0.001) followed by hypogonadism, after adjusting for age and BMI. Conclusions. This study demonstrates a clear association between ED and HIV infection, after adjusting for age and BMI. Other than HIV infection, hypogonadism was associated with ED. In addition, the prevalence of ED was higher in HIV-infected men than in HIV-uninfected men, in all decades of age. The early onset of ED in HIV-infected men could be considered a peculiar clinical hallmark of HIV and confirms precocious aging in these patients. ED should be of concern to clinicians when managing HIV-infected men even if the latter are young or middle aged. Zona S, Guaraldi G, Luzi K, Beggi M, Santi D, Stentarelli C, Madeo B, and Rochira V. Erectile dysfunction is more common in young, middle-aged HIV-infected men than in HIV-uninfected men. J Sex Med **;**:**–**. Key Words. HIV; Sexual Dysfunction; Erectile Dysfunction; Chronic Disease; IIEF-15; Premature Aging Introduction E rectile dysfunction (ED) is a complex phe- nomenon recognizing both psychogenic and organic (hormonal, vascular, and neurological) pathophysiological mechanisms [1,2]. It consists of “the inability to obtain or to maintain a penile erection sufficient to allow a satisfactory sexual activity” [1]. Prevalence of ED in the general male population varies from 2% to 70% [3–6]. Most of these studies on ED focused on individuals aged greater than 40 years [3–5]. Just a few studies included younger individuals [3,6,7], suggesting that ED is a peculiar pathological condition of 1 © 2012 International Society for Sexual Medicine J Sex Med **;**:**–**