Å. Mellgren , E. Carlsson-Lalloo [1,2], V. Svedhem [3,4], M. Rusner [1,5], M. Berg [1,6]
Affiliates:  Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden.  Clinic of Infectious Diseases, South Älvsborg Hospital, Borås, Sweden.  Karolinska University Hospital, Department of Infectious Diseases, Stockholm, Sweden.  Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.  Södra Älvsborg Hospital, Department of Research, Borås, Sweden.  University of Gothenburg, Gothenburg, Centre for Person-Centred Care (GPCC), Gothenburg, Sweden.
The increasing access to ART and its effectiveness are factors that improve health and life expectancy in HIV positive individuals, however the quality of life is reported as lower than in general population in many studies. Sexual well-being is an important part of good health, and in a recent meta-synthesis focusing on women (Lalloo et al.) we found that HIV infection was a burden in relation to sexuality and reproduction. The association of being well-treated on ART in regard to self-reported sexual satisfaction is not known, and we hypothesized that being well-treated on ART would be associated with sexual satisfaction.
To study the association between antiretroviral treatment outcome, self-reported physical and psychological health and sexual satisfaction in HIV-positive individuals.
This national observational study investigates self-reported sexual satisfaction in relation to health-related patient-reported outcome measures (PROM), antiretroviral treatment (ART), patient-related experience measures (PREM) (involvement in care, satisfaction with care provider) and socio-demographic data. Patients performed a validated (Marrone 2016) nine-item self-reported Health Questionnaire, an integrated part of the national registry InfCare HIV. 3798 patients, approximately 50% of the national cohort, were included between 2011-2016.
Overall, 43,4% of individuals were satisfied with their sexual life which is lower than in non-infected individuals. Longer time with hiv-diagnosis (RR=0.90, p<0.0001) and longer time on ART (RR=0.95, p<0.0001) were associated with less sexual satisfaction. U-shaped function of age (cut-off at 70 years) was related to greater sexual satisfaction, Figure 1. Only 32,6% of persons infected by iv drug use were satisfied their sexual life compared to 38,6% of homo/bisexuals and 47,8% of heterosexuals p<0.0001. People born abroad were more satisfied with their sexual life (RR=1.25, p<0.0001). There was no difference in sexual satisfaction with regards to HIV viral load or obtaining HIV viral load < 50 cop/mL. People who reported higher sexual satisfaction were more satisfied with their physical and psychological well-being p<0.0001. They were also more satisfied with the quality of their health provider and felt more involved with their care, p<0.0001. A larger proportion of women (51,5%) were satisfied with their sexual life compared to men (39,5%), RR=1.30 p<0.0001.
We found no association between sexual satisfaction and HIV viral load, thus a hypothesis of non-infectivity as a determinant for a higher sexual-satisfaction was not shown. However, a strong relation to both physical and psychological well-being was found and need to be addressed to improve the quality of life in hiv-infected individuals.