|Can Nevirapine cause a loss in libido?
Oct 17, 2001
October 17th 2001. I am a healthy 41 year old heterosexual male who immediately began anti-retroviral treatment upon positive HIV diagnosis 3 years 10 months ago (December 1997). In 1993 I was diagnosed with Hepatis C. Upon HIV diagnosis in December 1997, where I presented with a viral load of 105,000 copies and my CD4 count was 190, my physician prescribed me the antiviral regimen of 3TC; d4T and Nevirapine (along with the 4oomg twice daily dosage of acyclovir I was already taking). Since 27th of February 1998 I have maintained an undetectable viral load and my most recent CD4 count on the 25th of September 2001 was 651 or 22. I have maintained a 100 adherance schedule to this treatment with no other side effects other than the expected slight rise in elevated ALT scores in my Liver Function Test and a noticeable absence in sexual libido. The concern is actually most in the noticeable loss in libido, that feeling of being 'horny.' It is something which I can measure veryday as being absent from my life now, where to get physically aroused in seeing an attractive female is a memory of the past; where to masturbate on a regular basis is not even considered a reality option. Involuntary erections just don't happen anymore (except once in a blue moon). My testosterone count is good, measured at 20.5 on the 7th of may, 2001. I would be pleased to hear on any further suggestions which you may have to offer as I have heard of other anecdotal cases where men have associated their Nevirapine use with a personal loss in erectile function, some to a more severe than I have experienced, as well as a loss in libido. One doctor suggested this may have to do with an enzyme in the liver. Thankyou. James. Australia.
| Response from Dr. Boyle
While idiosyncratic reactions can occur to many medications, this is not a common problem with Viramune (nevirapine) either in trials or clinical practive. While Viramune can cause liver damage, I'm not sure that the "liver enzyme" theory is a good one, since if this were the explanantion one would have expected to find this side effect in many other patients, and you don't. I would look carefully at your other medications, especially any antidepressants, and re-examine your labs. Even if your testosterone is "normal" you may still benefit from some supplementation and I would consider a trial of that. Also, your physician should perform a thorough evaluation and verify that there are no physical/psychological reasons for the problem.
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