Penile vascular status in young men living with HIV experiencing erectile dysfunction: A comparative cross‐sectional pilot study

Background: Erectile dysfunction in people living with HIV is a multifactorial disease, but the role of penile vascular status assessed by dynamic penile color Doppler echography is underexplored. Objectives: This study assessed penile vascular status in young males living with HIV experiencing erectile dysfunction, comparing them to HIV-negative controls stratified into young (<50 years) and middle-aged (51–60 years). Materials and methods: This monocentric, comparative cross-sectional study included young males living with HIV (18–50 years) on antiretroviral therapy for >12 months and HIV-negative individuals presenting with erectile dysfunction. We used dynamic penile color Doppler echography to evaluate penile vascular parameters such as peak systolic velocity, intima-media thickness, and end-diastolic velocity. Statistical analyses, including k-means clustering and stepwise multivariate logistic regression, assessed associations between clinical variables and vascular parameters. Results: Of 310 young males living with HIV screened, 50 (16.1%) reported erectile dysfunction and were enrolled, with 97 HIV-negative individuals included as controls. Pathological intima-media thickness was significantly higher (p = 0.004) in young males living with HIV (76%) than in young controls (49%) but comparable to middle-aged controls (76.1%). Stepwise multivariate logistic regression identified belonging to the young control group, compared to young males living with HIV, as a protective factor against pathological intima-media thickness (OR 0.353, 95% CI 0.138–0.902, p = 0.0295), while increasing age was a significant risk factor (OR 1.09, 95% CI 1.01–1.18, p = 0.0247). Relative inhomogeneity of clusters was tested demonstrating that membership in either the people living with HIV or HIV-negative group was a significant predictor of cluster assignment based on dynamic penile color Doppler echography parameters, independent of age (p = 0.0025). Discussion and conclusions: This study is the first to utilize dynamic penile color Doppler echography to evaluate erectile dysfunction in young males living with HIV, highlighting the association between HIV and early vascular alterations. Clinicians should incorporate routine sexual health evaluations into routinary out-patients visits, using erectile dysfunction as a potential indicator for further vascular screening and early intervention.