Abstract：
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.
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.
摘要：
背景：几乎所有患有人类嗜T淋巴细胞病毒1（HTLV-1）相关的脊髓病/热带痉挛性轻瘫（HAM/TSP）的患者都有一定程度的勃起功能障碍（ED），但在很大比例的HTLV-1携带者中也发现了ED。
目的：评估随访长达15年的HTLV-1感染者的ED演变。
方法：这项前瞻性队列研究包括患有ED的HTLV-1感染男性，年龄在18到70岁之间,从2004年1月到2019年12月。我们使用了国际勃起功能指数-5(IIEF-5)，扩展的残疾状态量表和Osame运动残疾量表，和膀胱过度活动症评分(OABSS)来定义和分层ED，神经残疾，膀胱功能障碍,分别。
结果：严重ED发展时间是主要结果。
结果：我们研究了90名患有ED的男性（平均±SD年龄，52.8±9.78岁）。在基线,42是携带者，16人可能有HAM/TSP，和32有明确的HAM/TSP。IIEF-5在携带者中最高，在明确的HAM/TSP患者中最低，而OABSS在携带者中最低，在明确的HAM/TSP患者中最高。中位随访时间（IQR）为8.50年（3.00-12.00）。IIEF-5在携带者和可能和明确的HAM/TSP患者中从基线到最后一次随访显着下降。末次随访时IIEF-5与OABSS呈负相关(r=-0.62,P<.001)。在生存分析中,与携带者(P=.001)和可能患有HAM/TSP的患者(P=.014)相比,患有明确HAM/TSP的患者发生严重ED的时间明显较短.基线时明确的HAM/TSP的存在与严重ED的发展独立相关，在调整基线年龄和前动物负荷后(危险比，6.74；P=.008）。
结论：对勃起功能的正式评估应该是对HTLV-1感染者进行常规临床评估的一部分；勃起功能恶化应该提醒临床医生神经系统恶化的可能性。
未经证实：这是首次描述HTLV-1感染男性ED病程的前瞻性队列研究。小样本量和血清阴性对照的缺乏是局限性。
结论：ED是HTLV-1感染的缓慢进展的临床表现，基线时神经系统受损程度是严重ED进展时间的主要预测因素。
目的：评估随访长达15年的HTLV-1感染者的ED演变。
方法：这项前瞻性队列研究包括患有ED的HTLV-1感染男性，年龄在18到70岁之间,从2004年1月到2019年12月。我们使用了国际勃起功能指数-5(IIEF-5)，扩展的残疾状态量表和Osame运动残疾量表，和膀胱过度活动症评分(OABSS)来定义和分层ED，神经残疾，膀胱功能障碍,分别。
结果：严重ED发展时间是主要结果。
结果：我们研究了90名患有ED的男性（平均±SD年龄，52.8±9.78岁）。在基线,42是携带者，16人可能有HAM/TSP，和32有明确的HAM/TSP。IIEF-5在携带者中最高，在明确的HAM/TSP患者中最低，而OABSS在携带者中最低，在明确的HAM/TSP患者中最高。中位随访时间（IQR）为8.50年（3.00-12.00）。IIEF-5在携带者和可能和明确的HAM/TSP患者中从基线到最后一次随访显着下降。末次随访时IIEF-5与OABSS呈负相关(r=-0.62,P<.001)。在生存分析中,与携带者(P=.001)和可能患有HAM/TSP的患者(P=.014)相比,患有明确HAM/TSP的患者发生严重ED的时间明显较短.基线时明确的HAM/TSP的存在与严重ED的发展独立相关，在调整基线年龄和前动物负荷后(危险比，6.74；P=.008）。
结论：对勃起功能的正式评估应该是对HTLV-1感染者进行常规临床评估的一部分；勃起功能恶化应该提醒临床医生神经系统恶化的可能性。
未经证实：这是首次描述HTLV-1感染男性ED病程的前瞻性队列研究。小样本量和血清阴性对照的缺乏是局限性。
结论：ED是HTLV-1感染的缓慢进展的临床表现，基线时神经系统受损程度是严重ED进展时间的主要预测因素。
