Recreational use of sildenafil by HIV-positive and -negative homosexual/bisexual males

OBJECTIVE: To conduct an epidemiologic review of sildenafil in homosexual and bisexual males focusing on concurrent use with club drugs and/or antiretroviral medications. DATA SOURCES: A search of MEDLINE was conducted (1966-September 2003), and an extensive manual review of journals was performed using the key search terms club drugs, sildenafil, antiretrovirals, and HIV. STUDY SELECTION AND DATA EXTRACTION: All articles identified from the data sources were evaluated and information deemed relevant was included. DATA SYNTHESIS: Several epidemiologic studies have reported that sildenafil is abused in a recreational fashion, typically with agents commonly known to be "club drugs." In this setting, sildenafil may reverse the impotence-inducing effects of the club drugs and restore sexual capabilities. Many implications of both recreational and nonrecreational use of sildenafil exist in relation to HIV disease. Concern has been raised regarding the potential effects on high-risk sexual practices. Also, several researchers have documented interactions between sildenafil and various club drugs, as well as with antiretrovirals intended for HIV disease. CONCLUSIONS: Serious concerns exist regarding the concurrent use of sildenafil with antiretrovirals and/or club drugs. Clinicians prescribing sildenafil to patients receiving protease inhibitor-containing antiretroviral regimens should be aware of the potential for reduced sildenafil metabolism with resultant adverse effects. Additionally, untoward effects may also occur when sildenafil is used concurrently with various club drugs including amyl and butyl nitrites ("poppers").