NNRTI therapy associated with better sexual satisfaction

Michael Carter
Published: 06 January 2004

HAART regimens containing non-nucleoside analogues (NNRTIs) are associated with improvements in sexual satisfaction, according to an Italian prospective quality of life study published in the December 15th edition of the Journal of Acquired Immune Deficiency Syndromes.

Earlier studies have indicated as many as 70% of individuals taking HAART experience sexual dysfunction, and several studies have found a significant association between the use of protease inhibitors and the development of sexual problems.

Between 1997 and 1998 investigators from seven Italian HIV clinics assessed the sexual satisfaction and health related quality of life of 809 patients. Individuals were asked: "During the past four weeks have you been satisfied with your sexual life?" They were then asked to score the level of their satisfaction on a scale from zero to 100. The extent to which patients were experiencing HIV-related symptoms was also scored on a three point scale, and individuals’ mental health was also assessed.

Data on months of exposure to NNRTIs and protease inhibitors were also gathered, as were demographic data.

At baseline, the median CD4 cell count was 259 cells/3, and mean viral load was 8,000 copies/mL. A little under a third of the study members had an AIDS diagnosis, 48% were injecting drug users, and 32% were women. HAART was being taken by 90% of patients (61% a protease inhibitor and 1% an NNRTI). During the study an additional 117 patients started a protease inhibitor and 201 individuals initiated NNRTI therapy (128 of whom had previously taken an protease inhibitor-containing regimen).

At enrollment the mean for sexual satisfaction was 40.3, by the close of the study this had increased to 44.9 (increase from enrollment p=0.01). Of the 209 individuals who took an NNRTI, no difference in sexual satisfaction was found for those who were previously naïve to HAART or has switched from a protease inhibitor (p=0.42). In multivariate analysis, the investigators found that the baseline characteristics associated with sexual satisfaction were age (p=0.04), HIV viral load (p=0.02), and mental health status (p=0.001).

During the course of the study, each six month period of NNRTI therapy (p=0.036), improvement in mental health status (p<0.001), and fall in HIV viral load (p=0.02) were significantly associated with improved sexual satisfaction.

The investigators suggest that the increased sexual satisfaction associated with NNRTIs could be because NNRTIs have a lower side-effect burden than protease inhibitors and are easier to adhere to. They suggest that further studies could clarify if “a lower incidence of sexual disturbances in people taking NNRTIs would enhance adherence to treatments.”

The conclude, “the fact that NNRTIs have been associated with an improvement in sexual satisfaction may be an additional reason to offer an NNRTI-containing regimen as a first-line scheme of HAART.”

Further information on this website


Murri R et al. Nonnucleoside reverse transcriptase inhibitor-containing regimens are associated with increased satisfaction with sexual life. Journal of Acquired Immune Deficiency Syndromes 34: 532 – 536, 2003.

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