Post Graduate Program of Health Sciences, Federal University of Bahia, Salvador, Bahia, CEP 40026-010, Brazil.
Ambulatório Multidisciplinar de HTLV-1, Hospital Universitário Professor Edgard Santos, Federal University of Bahia, Salvador, Bahia, CEP 40110-060, Brazil.
J Sex Med. 2023 Feb 27;20(3):269-276. doi: 10.1093/jsxmed/qdac050.
Virtually all patients with human T-lymphotropic virus 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) have some degree of erectile dysfunction (ED), but ED is also found in a large percentage of HTLV-1 carriers.
To evaluate the evolution of ED in individuals infected with HTLV-1 who were followed for up to 15 years.
This prospective cohort study included men infected with HTLV-1 who had ED, were aged 18 to 70 years, and were followed from January 2004 to December 2019. We used the International Index of Erectile Function-5 (IIEF-5), the Expanded Disability Status Scale and Osame Motor Disability Scale, and the Overactive Bladder Symptom Score (OABSS) to define and stratify ED, neurologic disability, and bladder dysfunction, respectively.
Time to development of severe ED was the main outcome.
We studied 90 men with ED (mean ± SD age, 52.8 ± 9.78 years). At baseline, 42 were carriers, 16 had probable HAM/TSP, and 32 had definite HAM/TSP. IIEF-5 was highest among carriers and lowest in patients with definite HAM/TSP, whereas OABSS was lowest in carriers and highest in patients with definite HAM/TSP. Median (IQR) follow-up was 8.50 years (3.00-12.00). IIEF-5 fell significantly from baseline to last follow-up among carriers and patients with probable and definite HAM/TSP. There was an inverse correlation between the IIEF-5 and the OABSS at last follow-up (r = -0.62, P < .001). In survival analysis, the time to development of severe ED was significantly shorter in patients with definite HAM/TSP when compared with carriers (P = .001) and those with probable HAM/TSP (P = .014). The presence of definite HAM/TSP at baseline was independently associated with the development of severe ED, after adjustment for baseline age and proviral load (hazard ratio, 6.74; P = .008).
Formal assessment of erectile function should be part of the routine clinical assessment of individuals infected with HTLV-1; worsening erectile function should alert clinicians to the possibility of neurologic deterioration.
This is the first prospective cohort study to describe the course of ED in men infected with HTLV-1. The small sample size and absence of seronegative controls are limitations.
ED is a slowly progressive clinical manifestation of HTLV-1 infection, and the degree of neurologic compromise at baseline is the main predictor of time to progression to severe ED.
几乎所有人类 T 淋巴细胞病毒 1（HTLV-1）相关性脊髓病/热带痉挛性截瘫（HAM/TSP）患者都有一定程度的勃起功能障碍（ED），但 HTLV-1 携带者中也存在很大比例的 ED。
评估随访长达 15 年的 HTLV-1 感染患者 ED 的演变情况。
这是一项前瞻性队列研究，纳入了患有 ED 的 HTLV-1 感染男性，年龄 18-70 岁，并于 2004 年 1 月至 2019 年 12 月期间接受随访。我们使用国际勃起功能指数-5（IIEF-5）、扩展残疾状况量表和 Osame 运动残疾量表以及膀胱过度活动症症状评分（OABSS）来分别定义和分层 ED、神经功能障碍和膀胱功能障碍。
主要结局为严重 ED 的发病时间。
我们研究了 90 名患有 ED 的男性（平均年龄±标准差，52.8±9.78 岁）。基线时，42 人为携带者，16 人为可能的 HAM/TSP，32 人为明确的 HAM/TSP。携带者的 IIEF-5 最高，而明确的 HAM/TSP 患者的 IIEF-5 最低，而 OABSS 则相反，携带者的最低，明确的 HAM/TSP 患者的最高。中位（IQR）随访时间为 8.50 年（3.00-12.00）。携带者和可能的以及明确的 HAM/TSP 患者的 IIEF-5 均从基线显著下降至最后一次随访。在最后一次随访时，IIEF-5 与 OABSS 呈负相关（r=-0.62，P<0.001）。生存分析显示，与携带者（P=0.001）和可能的 HAM/TSP 患者（P=0.014）相比，明确的 HAM/TSP 患者发生严重 ED 的时间明显缩短。基线时存在明确的 HAM/TSP 与严重 ED 的发生独立相关，在校正基线年龄和前病毒载量后（危险比，6.74；P=0.008）。
对于 HTLV-1 感染者，应将正式的勃起功能评估纳入常规临床评估；勃起功能恶化应提醒临床医生注意神经功能恶化的可能性。
这是第一项描述 HTLV-1 感染男性 ED 病程的前瞻性队列研究。样本量小且缺乏血清阴性对照是其局限性。
ED 是 HTLV-1 感染的一种缓慢进展的临床表现，基线时的神经损伤程度是进展为严重 ED 的主要预测因素。
