School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda.
BMC Infect Dis. 2022 Aug 15;22(1):692. doi: 10.1186/s12879-022-07673-z.
The literature on dolutegravir (DTG)-based HIV treatment has focused on assessing therapeutic efficacy particularly with regard to viral load suppression. However, little empirical attention has been devoted to understanding the effects of DTG on quality of life, in particular sexual health and functioning in PLHIV. This study focused on understanding patient experiences of sexual dysfunction, after transition to DTG-based regimens in Rwenzori region in Mid-Western Uganda.
We adopted a qualitative exploratory research design. Between August and September 2021, we conducted sixteen in-depth interviews and six focus group discussions (48 participants) with patients reporting 'new' sexual dysfunction after transition to DTG-based regimens at seven health facilities in mid-Western Uganda. Data were analyzed by thematic approach.
Decreased libido was reported in both sexes of patients within weeks of transition to DTG-based regimens. Diminished interest in sex was more frequently reported among women while men complained of a marked reduction in the frequency of sex. Women reported loss of psycho-social attraction to their long-term male partners. Erectile dysfunction was common among men in this sample of patients. Patients described their experiences of sexual dysfunction as an affront to their socially-constructed gender identities. Patients described tolerating sexual adverse drug reactions (ADRs) as a necessary tradeoff for the extension in life granted through antiretroviral therapy. A number of women reported that they had separated from their spouses as a result of perceived drug-induced sexual dysfunction. Marital strife and conflict arising from frustration with sexual-partner dysfunction was frequently reported by participants in both sexes. Several participants indicated experiencing insecurity in their heterosexual relationships due to difficulties in sexual functioning.
Sexual dysfunction following transition to DTG-based regimens is common in both sexes of PLHIV, who indicated that they had no prior experience of difficulties in sexual health. Our findings demonstrate that sexual ADRs negatively impact self-esteem, overall quality of life and impair gender relations. DTG-related sexual health problems merit increased attention from HIV clinicians. Further research is warranted to assess the prevalence of DTG-associated sexual dysfunction in patients in Uganda.
关于多替拉韦（DTG）为基础的 HIV 治疗的文献主要集中在评估治疗效果上，特别是在病毒载量抑制方面。然而，很少有实证研究关注 DTG 对生活质量的影响，特别是对 PLHIV 的性健康和功能的影响。本研究关注的是在乌干达中西部 Rwenzori 地区，了解患者在转换为 DTG 为基础的方案后性障碍的体验。
我们采用了定性探索性研究设计。在 2021 年 8 月至 9 月期间，我们在乌干达中西部的 7 家卫生机构，对 48 名报告在转换为 DTG 为基础的方案后出现 "新 "性障碍的患者进行了 16 次深入访谈和 6 次焦点小组讨论。数据通过主题方法进行分析。
在转换为 DTG 为基础的方案后几周内，患者的性欲下降。在女性中，对性的兴趣减少更为常见，而男性则抱怨性频率明显减少。女性报告说，她们对长期男性伴侣失去了心理社会吸引力。在本研究样本中，男性普遍存在勃起功能障碍。患者将性药物不良反应（ADR）的经历描述为对他们社会构建的性别认同的一种侮辱。患者将耐受性药物不良反应（ADR）作为获得抗逆转录病毒治疗带来的生命延长的必要代价。一些女性报告说，她们已经与配偶分居，因为她们认为药物导致了性障碍。性伴侣功能障碍引起的婚姻不和和冲突在两性参与者中经常被报告。一些参与者表示，由于性功能障碍，他们对异性关系感到不安全。
在 PLHIV 的两性中，转换为 DTG 为基础的方案后，性障碍很常见，他们表示以前没有过性健康问题。我们的研究结果表明，性 ADR 对自尊心、整体生活质量和性别关系产生负面影响。DTG 相关的性健康问题值得 HIV 临床医生的更多关注。需要进一步研究来评估乌干达患者中 DTG 相关性障碍的患病率。
