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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
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Impotence and protease inhibitors
Jun 11, 2000

My lover is HIV+ and has been for 15 years. He has been experiencing inability to have an erection and is taking Viagra. I am a cardiac clinical nurse specialist and worry about the possible side effects of Viagra with his treatment regimen. Are protease inhibitors contributing/causing his impotence? What literature is available regarding this side effect and could you explain the physiology/pharmacology behind this. Thanks for any help!

Response from Dr. Henry

Impotence is common in the general population and perhaps is more common among HIV+ men. Of course there is a psychologic component in many cases due to the HIV+ status and transmission concerns. There is a high rate of hypogonadism (unexplained as far as I am concerned) among HIV+ men that is not linked to any particular treatment. Protease inhibitors, through their inhibition of liver enzymes, can markedly diminish the clearance of Viagra from the blood stream leading to high levels for a prolonged period of time. Thus, use of Viagra with PIs (especially ritonavir and indinavir) should be with much caution using low doses and then titrating up very carefully. Keith Henry, M.D.

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