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Sexual problems
While sexual dysfunction can be a problem for anyone, people living with HIV may be particularly affected. Loss of sexual drive or desire (libido) can have a significant impact on quality of life and feelings of self-worth, and may even contribute to emotional problems such as anxiety and depression
Sexual problems are common during times of stress, such as when one receives an HIV-positive diagnosis or experiences work or relationship difficulties. Excessive intake of alcohol or recreational drugs can also diminish both the desire and ability to have sex.
Many of the drugs commonly used to treat depression, e.g. fluoxetine (Prozac) or paroxetine (Seroxat) can also affect sexual function. Additionally, megestrol acetate (Megace), an appetite stimulant, has been shown to cause loss of libido.
Sexual dysfunction among men can often be a result of decreased testosterone levels (hypogonadism), which can also lead to fatigue. Lower than normal testosterone levels have been found in people with advanced HIV infection, and can be caused both by the direct effects of HIV or simply by chronic ill health. Many men receive testosterone treatment to alleviate these problems. Men who use testosterone replacement therapy usually gain muscle mass and experience an emotional ‘lift' and an increase in their libido.
Erectile dysfunction (impotence, or the inability to get or maintain an erection) can be caused by HIV damaging the nerves in the penis which control an erection (autonomic neuropathy). Similarly, anti-HIV drugs that cause neuropathy, such as ddC (zalcitabine, Hivid), ddI (didanosine, Videx) and d4T (stavudine, Zerit), may cause numbness in the genital area, which can make it difficult to sustain an erection. Protease inhibitors have also been reported to cause impotence, with some evidence suggesting that those containing ritonavir (Norvir) are particularly likely to cause sexual dysfinction.
Drugs including Viagra and Cialis are tablets used to treat impotence. They work by increasing blood flow to the penis, making it more sensitive to touch. However, these drugs should be taken with care by people using protease inhibitors, NNRTIs, ketoconazole, itraconazole or erythromycin. You should reduce by half the normal dose of the sexual dysfunction drug you are taking. For people taking ritonavir, it is recommended that Viagra should not be used at all, given the potential health risks. Similarly, the recreational drug poppers must not be used with Viagra or Cialis.