Neurologic disability predicts severe ED in men infected with HTLV-1

Patients with human T-lymphotropic virus 1 (HTLV-1) infection may develop erectile dysfunction (ED), and time to progression to its severe form is significantly associated with the degree of neurologic compromise at baseline, reveals a study.

This prospective cohort study sought to examine the evolution of ED in individuals infected with HTLV-1 who were followed for up to 15 years. Participants included men with HTLV-1 who had ED, aged 18‒70 years, and were followed from January 2004 to December 2019. Median follow-up was 8.5 years.

The investigators defined and stratified ED, neurologic disability, and bladder dysfunction using 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), respectively.

Ninety men with ED (mean age 52.8 years) met the inclusion criteria. Of these, 42 were carriers, 16 had probable HLTV-1‒associated myelopathy/tropical spastic paraparesis (HAM/TSP), and 32 had definite HAM/TSP at baseline.

Carriers had the highest IIEF-5, while patients with definite HAM/TSP had the lowest. On the other hand, OABSS was lowest in carriers and highest in those with definite HAM/TSP.

From baseline to follow-up, IIEF-5 significantly decreased among carriers and patients with probable and definite HAM/TSP. An inverse relationship was observed between IIEF-5 and the OABSS at last follow-up (r, ‒0.62; p<0.001).

Survival analysis revealed significantly shorter time to development of severe ED in patients with definite HAM/TSP relative to carriers (p=0.001) and those with probably HAM/TSP (p=0.014). After adjusting for baseline age and proviral load, the presence of definite HAM/TSP at baseline independently correlated with the development of severe ED (hazard ratio, 6.74; p=0.008).

“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,” the investigators said.