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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
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sexual dysfunction
Nov 12, 2003

Dear Doctor: Since beginning a cocktail of kaletra, amprenivir, epivir that is combined with viread, I have not been able to stimulate any kind of erection. I'm cognizant that the meds have this kind of effect, but what exactly has happened to me? My physician explains that it is directly involved with the intake of the aforementioned drugs. I have tried both viagra and levitra, only to dismiss their use because of profound headaches and sinus problems. What causes this inability to get erect? I realize it has something to do with the blood flow,but I would like this explained to me in layman's terms. Would it be propitious for me to see a urologist, or is this a waste of time? Are there any remedies to this problem that I might consider? In addition, I feel so emasculated that it has begun to effect me psychologically in a profound way. Thank you ever so much for any assistance.

Response from Dr. Wohl

First of all, Kaletra and amprenavir (Agenerase or its prodrug Lexiva) should not be combined as a drug-drug interaction lowers the levels of each of the protease inhibitors. If your doctor does not know this, share this report on with her/him

A change in your HIV therapy (as it sounds like you need) may do the trick.

Important questions that I ask when patients complain of impotence are: do you get morning erections? (If so the machinery is working). Are there any other drugs you can be taking that effect libido? (Antidepressants, for example).

It sounds like you have asked this question before ( and I agree with Dr. Henry that an endocrine (assessment of testosterone levels) and urologic work up are warranted. DW

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