Prevalence and Factors Associated with Erectile Dysfunction Among Men Living with HIV: A Systematic Review, Meta-Analysis, and Meta-Regression

Objectives Erectile dysfunction is common among men living with HIV, but the characteristics associated with it have not been pooled quantitatively. We estimated its prevalence and compared men with and without erectile dysfunction.Methods PubMed, Scopus, Epistemonikos, Scilit, and ProQuest were searched to 15 May 2026 for observational studies of men living with HIV reporting the prevalence of erectile dysfunction and data stratified by its presence (PROSPERO CRD420261408614). Risk of bias was assessed with the Risk Of Bias In Non-randomized Studies of Exposures tool. Prevalence, odds ratios, and mean differences were pooled with random-effects models. Heterogeneity was explored with subgroup analyses and meta-regression, and p-values were adjusted for multiple comparisons.Results Sixteen studies (5,017 men) were included. The pooled prevalence of erectile dysfunction was 53% (95% confidence interval 44%–62%; I2 = 96.8%) and was higher in studies using questionnaires based on the International Index of Erectile Function than in those using clinical diagnosis or self-report (p = 0.021). After adjustment for multiple comparisons, erectile dysfunction was associated with older age (mean difference 3.2 years), hypertension (odds ratio 2.28, 95% confidence interval 1.88–2.77), diabetes mellitus (2.01, 1.44–2.82), psychiatric disorders (1.91, 1.54–2.37), hypogonadism (1.92, 1.42–2.61), and antiretroviral therapy use (1.62, 1.27–2.08). Lower nadir and current CD4 cell counts, acquired immunodeficiency syndrome, lower total testosterone, dyslipidemia, and, inversely, alcohol use were associated with erectile dysfunction at false discovery rate-adjusted significance only. No antiretroviral class was associated with erectile dysfunction, and fewer than one in four affected men used phosphodiesterase type 5 inhibitors.Conclusions About half of men living with HIV have erectile dysfunction, although estimates depend strongly on how it is measured. Erectile dysfunction is associated with age and with cardiometabolic, psychological, endocrine, and treatment-related factors. Erectile function should be assessed routinely in HIV care, followed by evaluation of these contributors.