Interferon-based Therapy May Interfere with Sexual Desire and Function in Men Treated for Chronic Hepatitis C

Men undergoing treatment for chronic hepatitis C virus (HCV) infection using pegylated interferon plus ribavirin commonly experience altered sexual desire, impaired sexual function, and reduced satisfaction from sex, according to study published in the September 2009 issue of Gastroenterology. While these problems typically improve after completing treatment, some degree of dysfunction may persist.

By Liz Highleyman

Interferon-based therapy for hepatitis C has several well-known side effects, including depression and blood cell deficiencies (anemia and neutropenia). Sexual side effects, however, have not been extensively studied.

To address this gap, researchers with the Virahep-C Study Group evaluated the impact of anti-HCV therapy on male sexual health. The Virahep-C trial, sponsored by the National Institutes of Health, was designed to look at factors associated with treatment response, focusing on differences between whites and African-Americans (who tend to respond more poorly, for reasons that are not yet clear).

The present analysis included 260 men with HCV genotype 1. About half were African-American and half were Caucasian-American. The median age was just under 50 years; the authors' summary did not state the participants' sexual orientation.

All patients were treated with 180 mcg/week pegylated interferon alfa-2a (Pegasys) plus 1000-1200 mg/day weight-adjusted ribavirin. Those who did not achieve undetectable HCV viral load by week 24 stopped treatment, while responders continued therapy through 48 weeks.

Participants completed self-administered questionnaires concerning sexual desire, sexual function (including erectile and ejaculatory function), and sexual satisfaction before, during, and after treatment.

Results

	Before starting treatment, 37% of the men reported some degree of impaired sexual desire and 44% reported dissatisfaction with their sex life.
	Prior to therapy, 26% reported impaired erectile function and 22% reported impaired ejaculatory function.
	During treatment, the men experienced significant declines in all components of sexual health, compared with pre-treatment levels.
	At the end 24 or 48 weeks of therapy, 38% to 48% of the men reported that their overall sexual functioning was worse than it was before starting treatment.
	African-American patients reported less impairment in sexual desire and satisfaction than white patients during therapy.
	By 24 weeks after treatment -- the point at which sustained virological response (SVR) is determined -- sexual desire and satisfaction had improved, reaching levels comparable to those at baseline.
	Among men who received the full 48 weeks of therapy, more reported post-treatment erectile or ejaculatory problems than did so at baseline.
	Persistent erectile dysfunction, however, was limited to white patients.

Based on these findings, the study authors concluded, "Sexual impairment is common among men with chronic hepatitis C undergoing therapy with pegylated interferon and ribavirin and should be considered as a potential side effect of antiviral therapy."

They added that men considering treatment should be counseled about the possibility of decreased sexual health during therapy.

Division of Gastroenterology and Hepatology, New York Presbyterian Medical Center, New York, NY; New England Research Institutes, Watertown, MA; Department of Epidemiology and Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; Liver Disease Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.

10/02/09

Reference
LM Dove, RC Rosen, D Ramcharran, and others. Decline in male sexual desire, function, and satisfaction during and after antiviral therapy for chronic hepatitis C. Gastroenterology 137(3): 873-884. September 2009. (Abstract).