The Cumulative Effects of Medication Use,Drug Use,and Smoking on Erectile Dysfunction Among Men Who Have Sex with Men

IntroductionErectile dysfunction (ED) is highly prevalent among human immunodeficiency virus‐seropositive (HIV+) men who have sex with men (MSM). There is a need for additional research to determine the correlates of HIV+ and HIV‐seronegative (HIV?) MSM, especially regarding nonantiretroviral medication use.AimsThis study examined the prevalence of ED and the sociodemographic, medical conditions, medication use, and substance use correlates of ED among HIV+ and HIV? MSM.MethodsA modified version of the International Index of Erectile Function (IIEF) for MSM was self‐administered by participants enrolled in the Multicenter AIDS Cohort Study, an ongoing prospective study of the natural and treated histories of HIV infection among MSM in the United States. The study sample included 1,340 participants, including 612 HIV+ and 728 HIV? men. Poisson regression with robust error variance was used to estimate prevalence ratios of ED in multivariable models in combined (HIV+/?) and separate analyses.Main Outcome MeasureED was determined by the summed scores of a modified version of the IIEF validated among MSM.ResultsTwenty‐one percent of HIV+ MSM and 16% of HIV? MSM reported ED. Being >55 years of age, black race, cumulative pack years of smoking, cumulative antihypertensive use, and cumulative antidepressant use had significant positive associations with the prevalence of ED in the total sample. Among HIV+ men, duration of antihypertensive use and antidepressant use were significantly associated with increasing prevalence of ED. Among HIV? men, being >55 years of age, black race, and cigarette smoking duration were associated with increased prevalence of ED.ConclusionPredictors of ED may differ by HIV status. Although smoking cessation and effective medication management may be important as possible treatment strategies for ED among all MSM, there may be a burden on sexual functioning produced by non‐HIV medications for HIV+ men. Hart TA, Moskowitz D, Cox C, Li X, Ostrow DG, Stall RD, Gorbach PM, and Plankey M. The cumulative effects of medication use, drug use, and smoking on erectile dysfunction among men who have sex with men. J Sex Med 12;9:1106–1113.     

Agomelatine for depression: expanding the horizons?

Introduction: Agomelatine is an antidepressant with unique pharmacological actions; it is both a melatonin agonist and selective serotonin antagonist. Both actions combined are necessary for antidepressant efficacy. Effects on melatonin receptors enable resynchronisation of disrupted circadian rhythms with beneficial effects on sleep patterns.

Areas covered: The issue of use of an antidepressant for depression co-morbid with somatic disorders is covered by the authors. A review of the literature from 2000 to August 2018 was undertaken using Scopus and Web of Science with the key words: agomelatine, depression, medical illness. Depression in Parkinson’s disease, cardiovascular illness and type II diabetes is reviewed with evidence of efficacy. Bipolar depression and seasonal affective disorder may also react favourably. Agomelatine may have specific efficacy on symptoms of anhedonia.

Expert opinion: Despite approval in some major jurisdictions, the drug has failed to gain registration in the United States. A defining issue may be questions about longer term efficacy: unequivocal effectiveness in placebo-controlled relapse prevention studies has not always been demonstrated. Continuation studies suggest maintenance of clinical responsiveness. A major disadvantage of the drug is its’ potential hepatotoxicity and the need for repeated clinical laboratory tests.