Sexual Dysfunction Among Males Living with HIV Receiving Dolutegravir-Based Antiretroviral Therapy in Uganda: A Cross-sectional Study

BACKGROUND: Dolutegravir, the anchor drug of combination antiretroviral therapy (cART), has been associated with sexual dysfunction. We have evaluated the burden, correlates and nature of sexual dysfunction among Ugandan males living with HIV receiving dolutegravir-based antiretroviral therapy. METHODS: In a cross-sectional study in one health centre, we collected sociodemographic and clinical data via structured interviews, undertook clinical examinations and performed data abstraction from electronic medical records. Sexual function was evaluated using the International Index of Erectile Function and the Changes in Sexual Functioning Questionnaire. Modified Poisson regression was utilised to estimate prevalence ratios (PRs), modelling dolutegravir exposure as the primary independent variable while adjusting for sociodemographic and clinical factors as secondary covariates. RESULTS: The prevalence of erectile dysfunction among males receiving dolutegravir-based cART for > 1 day to 6 months was twice that of cART-naive males (59% vs 26%) and plateaued thereafter. Dolutegravir exposure was associated with erectile dysfunction with adjusted PRs > 2 at all timepoints (> 1 day to > 2 years) compared with cART-naïve males. Older age, living with a partner, self-reported adherence, and moderate-to-severe depression were also associated with sexual dysfunction. Sexual desire frequency dysfunction was associated with dolutegravir exposure among males receiving dolutegravir for > 1 day to 6 months (PR 1.15, 95% CI 1.05-1.26) versus > 2 years. CONCLUSIONS: Dolutegravir is associated with transient central sexual desire suppression and persistent peripheral erectile dysfunction. This has the potential to lead to non-adherence and virological rebound, which needs to be monitored to safeguard the long-term success of cART.