Sexual Problems in Men with Hepatitis C

By Liz Highleyman

Sexual dysfunction is common among men with chronic hepatitis C and has a negative impact on quality of life, according to a study published in the June 2006 issue of the American Journal of Gastroenterology.

Researchers prospectively enrolled 112 HCV positive and 239 HCV negative men, who completed questionnaires to assess sexual functioning (Brief Male Sexual Function Inventory, or BMSFI), depression (Beck Depression Inventory), and health-related quality of life (Medical Outcomes Study Short Form-36). The BMSFI included assessment of sex drive, erectile function, ejaculation, reported sexual problems, and overall sexual satisfaction). Men with other medical conditions associated with sexual dysfunction (e.g., diabetes, kidney failure, prostate cancer) were not included.

Results

Men with hepatitis C had significantly more sexual dysfunction compared with HCV negative men across all five domains of the BMSFI.

HCV positive men were significantly more likely to report a lack of sexual satisfaction (53.6% vs 28.9%; P < 0.001), even after adjusting for age, race, and other potential confounding variables (OR 3.36; 95% CI 1.59-7.13).

About twice as many HCV positive men reported using sildenafil (Viagra) in the past month compared with HCV negative men (19.6% vs 9.6%).

High HCV viral load and elevated ALT were associated with a higher rate of sexual problems.

Hispanic ethnicity was associated with a lower rate of sexual dysfunction; in contrast with some past research in HIV negative men, older age was not associated with sexual problems.

Among the 38 men who received liver biopsies, those with advanced fibrosis (stage 3 or 4) were slightly more likely to report sexual dissatisfaction (75% vs 50%; P = 0.15).

Among the 241 men without depression - which is itself linked with sexual problems -- HCV positive men were still significantly more likely to report lack of sexual satisfaction than HCV negative men (47.5% vs 11.0%; P < 0.001).

HCV positive men who were not sexually satisfied scored significantly worse on six out of eight domains of health-related quality of life compared with HCV positive men who were sexually satisfied.

Conclusion

The researchers concluded that, "Sexual dysfunction is highly prevalent in men with chronic HCV infection, is independent of depression, and is associated with a marked reduction in [health-related quality of life]."

The reasons for sexual problems among men with hepatitis C are poorly understood, though changes in the hypothalamic-pituitary-gonadal hormonal feedback axis related to HCV infection or its treatment may play a role. A previous German study, for example, found that treatment with interferon/ribavirin was associated with decreased serum testosterone levels.

The authors noted that these findings have important public health implications, given that there are more than 2 million men with chronic hepatitis C in the United States. They suggested that HCV infection should be considered in the differential diagnosis of sexual dysfunction in men, and recommended further study of the virological and biological factors that contribute to sexual problems in this population.

7/18/06

Reference
A Danoff, O Khan, D W Wan, and others. Sexual dysfunction is highly prevalent among men with chronic hepatitis C virus infection and negatively impacts health-related quality of life. American Journal of Gastroenterology 101(6): 1235-1243. June 2006.