Sexual dysfunction in an aging HIV positive population compared to HIV negative control groups. Results from the German 50/2010 cohort study

Transcription

1 1st International Workshop on HIV & Aging Baltimore, MD, USA 4-5 October 2010 Sexual dysfunction in an aging HIV positive population compared to HIV negative control groups. Results from the German 50/2010 cohort study B. Mueck, C. Koegl, E. Wolf, M. Karwat, A. Baumgarten, M. Rausch, C. Mayr, G. Klausen, V. Hanhoff, G. Knecht, G. Trapana, H. Jaeger O 10 presented by Gesa Trapana

2 Introduction HIV + DM Controls Socio-economic factors Sex m/f Age Comorbitities Medication Physical activity 50 years old

3 Design 37 HIV outpatient clinics and private practices Prospective nationwide multicenter cohort study N=750 patients aged 50 years 250 HIV + patients 250 Diabetes mellitus II (DM) 250 control patients without any severe chronic or malignant disease Visits at baseline, month 6, month 12 and month 18

4 Recruitment last patient in 12/2009

5 Inclusion criteria Age of patients 50 years at the time of inclusion Patient informed consent No acute life-threatening disease No malignant disease requiring treatment HIV+: Existing HIV infection (longer than 1 year) and no acute opportunistic infection at the time of study entry DM: Diabetes mellitus II Control patients: patients without any severe chronic or malignant disease Possible e.g. hypertension, hyperlipidemia, depression, HCV or HBV co-infection, history of heart attack (>1 year ago)

6 Data Collection Variables Sex, age, weight, BMI, waist circumference Grip strength, blood pressure, pulse Pre-existing and emerging co-morbidities Current medication Laboratory parameters (hematology, lipids, liver enzymes, creatinine, glucose) Patient questionnaires SF-36 questionnaire on quality of life and psychological well-being HADS-D depression questionnaire AMS questionnaire on sexuality and aging MMST (Mini-Mental-Status-Test) questionnaire for cognitive deficits Physical activity and socio-demographic situation Alcohol consumption and smoking

7 AMS Questionnaire (AMS) Aging Male Symptoms Scale = self-reported one-page questionnaire with 17 items addressing psychological, somatic and sexual symptoms used in the male study population across the three groups to compare symptoms of aging and sexual complaints

8 AMS Questionnaire

9 AMS Questionnaire

10 AMS Questionnaire Evaluation Total AMS 17 items with scores from 1 5 range of total score Total AMS scores 37 indicate moderate/severe subjectively perceived complaints. AMS-S Sexual subscale 5 items with scores from 1 5 range of total score 5 25 AMS-S scores 11 indicate a severe reduction of sexual function.

11 Statistics Multivariate logistic regression analysis was used to evaluate the factors independently associated with AMS 37 (moderate/severe complaints) AMS-S 11 (severe reduction of sexual function) Variables included in the model HIV+ infection Diabetes Body mass index Stable partnership Age groups (60-69 years and years vs years)

12 Baseline characteristics 505 male patients with complete AMS questionnaire HIV+ DM II Controls Patients [N] Median age [years] p=0.006 Median BMI [kg/m 2 ] p<0.001 Proportion BMI > 28 [%] p<0.001 Stable partnership [%] p<0.001 Median total AMS-Score p<0.001 Median AMS-S score p<0.001

13 Total AMS score 37

14 Total AMS score 37 Stratified by age group HIV+ DM control patients 100 Patients with AMS-Score >=37 [%] years years years

15 Total AMS score 37 AMS score 37 OR 95% CI p-value HIVinfection vs no HIVinfection <0.001 Diabetes mellitus II vs no DM <0.01 Without stable partnership vs stable partnership <0.01 BMI >28 vs BMI Age vs years Age vs years

16 Sexual Subscale: AMS-S score 11 Severe reduction of sexual function 52% of HIV 48% of DM 33% of control patients p <0.001 (Kruskal-Wallis test)

17 Sexual Subscale: AMS-S score 11 Stratified by age group Patients with AMS-S Score >=11 [%] HIV+ DM control patients years years years

18 Sexual Subscale: AMS-S score 11 Only HIV-infection and not diabetes mellitus was associated with an AMS-S score 11. A strong impact factor was advanced age 70 years. AMS-S score 11 OR 95% CI p-value HIVinfection vs no HIVinfection Diabetes mellitus II vs no DM Without stable partnership vs stable partnership BMI >28 vs BMI Age vs years Age vs years <0.001

19 Conclusions Higher total AMS scores representing the severity of symptoms of aging incl. psychological, somatic and sexual complaints were more often observed in HIV positive and in diabetes mellitus II patients than in control patients. In the AMS sexual subscale, the subjectively perceived reduction in sexual function was strongly associated with HIV infection, but not with diabetes mellitus II. Advanced age was strongly associated with a reduction in sexual function.

20 Outlook 50/2010 substudy HYPE (Hypogonadism in Aging Males) Total testosterone (SHBG) Sexual hormone binding globulin Albumin Free testosterone (LH) Luteinising hormone in the context of AMS Questionnaire

21 Acknowledgments DAGNÄ Statistical analyses: MUC Research, Munich Financial Support: Abbott Boehringer Ingelheim Gilead Sciences GlaxoSmithKline MSD Sharp & Dohme Tibotec ViiV Healthcare Participating centers and patients

22 Participating centers The 50/2010 Study Group Dr. Baumann, Neuss Dres. Baumgarten/Dupke/Carganico, Berlin Dres. Brust/Schuster/Ploeger/Hensel, Mannheim Dres. Busch/Christensen, Muenster Dres. Denger/Sammler, Friedrichsthal Dr. Dix, Konstanz Dres. Friese/Cseke, Giessen Dres. Gippert/Hartmann/Quaing, Muenster Dr. Gospodinov, Saarbruecken Dr. Haberl, Frankfurt Dres. Hanhoff/Fussen, Geilenkirchen Dres. Klausen/Hintsche, Berlin Dres. Hoffmann/Hansen, Hamburg Dres. Jaegel-Guedes/Jaeger, Munich Dr. Karwat, Munich Dr. Knecht/Klauke, Frankfurt Dres. Koeppe/Kreckel, Berlin Dres. Kuhlmann/Holm/Heiken, Hannover Dr. Lauenroth-Mai, Berlin Dr. Mauruschat, Wuppertal Dres. Mayr/Schmidt, Berlin Dr. Meurer, Munich Dres. Mosthaf/Procaccianti/Zutavern- Bechtold, Karlsruhe Dres. Pauli/Becker, Munich Dres. Plettenberg/Stoehr/ifi, Hamburg Dres. Rausch/Freiwald, Berlin Dres. Reith/Gottstein, Duesseldorf Dr. Schappert, Mainz Dr. Schlote, Berlin Dr. Schölzel, Troisdorf Dres. Schranz/Fischer, Berlin Dr. Schuler, Berlin Dr. Stündel, Berlin Dr. Ulmer/Frietsch/Mueller, Stuttgart Dr. Usadel, Freiburg Dr. Wuensche, Berlin Dr. Zebhauser, Munich