Q and A


Did erectile dysfunction drugs cause viral load increase?

I am a married man and was diagnosed 3 years ago. I have been receiving support from my spouse and she is negative and tested negative. I was on ARVs and started Atripla about a year ago.

My CD4 and viral load was undetectable since January 2013. I went for a checkup in July and it shot up to 2000. I have not missed a single dose of Atripla, but maybe when I was taking it was a hour apart and not exactly the same time.

My doctor said I should take it the same time everyday. I was scared to mention to the doctor that I did go to the local men’s health clinic for erectile dysfunction and they gave me some nose drops to take to help with that. I did not tell them my status cos I was embarrassed.

I want to know will me taking any medication for erectile dysfunction affect my viral load. Also I came across a gel or tablet called kamagra gel, which can be used for erectile dysfunction. Can I take that and will it affect my viral load and CD4 count? Will taking any medication for erectile dysfunction affect my viral load as I am on Atripla and am happy with the Atripla. I don’t have any side effects. My viral load and CD4 count was undetected for the past 2 and a half years until this year July when I went for my checkup and blood test. I am 41 yrs old.



Thanks for your email. There are a few issues that you bring up and I will deal with these separately.

1) The increase in your viral load.

It is very important that your doctor checks to see if this result is a ‘blip’ and it goes back down, or if your viral load is increasing. If your viral load is confirmed as increasing this could mean that you have developed some resistance to one or all of the drugs in Atripla. If this is the case you will need to change to a different treatment to get your viral load back down to undetectable.

Please have look at this page, which explains the difference between a viral load blip and a true rebound.

2) Treatment for erectile dysfunction (ED)

It is important that your HIV doctor knows about any other drugs you are using- including any complementary therapies and over the counter tablets. Without knowing the name of the ED drugs the clinic gave you I can’t check if these could have affected your treatment. But many drugs do interact with Atripla and it is possible that the nose spray you were given is one of these.

It’s a good idea to try and talk to your doctor about the erection problems you are having. Although this can be embarrassing many HIV positive men have similar experiences and your doctor will probably have dealt with many similar situations. Erectile dysfunction can in some cases be connected to another health condition too, so it’s important that the doctor knows about this. S/he should be able to prescribe treatment to help with this that can be used safely with your ARVs. There is more information about erectile dysfunction on the NHS website.

3) CD4 count and viral loads
You mention in your email that your CD4 count and viral load were both ‘undetected’. Viral loads can be undetectable but your CD4 count should be a number- anything between 1 and 1600. It’s worth knowing your CD4 count because this is a measure of how strong your CD4 count is. There is a guide to CD4 and viral load tests on our website.


  1. Lisa Thorley

    Hi Andy,

    If you are having issues, please discuss this with your doctor. This is unlikely to be due to the meds that you’re taking.

  2. Andy

    I have been using Hefteman antiretrovirals for about 2 weeks…I was using Tribuss and didn’t experience any problems,however with the Hefteman I seem to be having an erection deficiency…is that normal??

  3. Robin Jakob

    Hi Daniel,

    Ritonavir is used to increase the levels of other protease inhibitors. The problem with this is that it can also increase the levels of other medications. This is also the case with Viagra. To avoid side effects cause by increased levels of viagra people do dose adjust and take less. It is a good idea to talk to your clincic about this interaction though. Alternatively you could ask for an opinion form a different clinic.

    You can find more information about Ritonavir interactions here:

  4. Daniel


    I just wanted to ask a question regarding the interaction between ritonavir (100 mg) and sildenafil (Viagra) (50 mg). I read in the leaflet of ritonavir that it should not be taken together with sildenafil by patients with pulmonary hypertension, but it still can be taken for erection. Is that true? Are there any side effects to expect in that case? I don’t want to consult it directly with my doctor because I use Viagra just to enhance my erection and not to treat any real erectile dysfunction.

    Thank you for your answer.


  5. Mohammed


    I did read the link. Can viagar or the generic to viagra be taken together with atripla.
    I find atripla very effective and I have no side effects. its just that it makes me sleepy at night, but other than that i am in good health.

    Thanks for all your help. Do you perhaps know of a place I can call in South africa that are confidential and will be able to assit me fursther with any concerns, that i may have.

  6. Rebecca McDowall

    Hi Mohammed,
    Viagra may be less effective when taken together with Atripla. This is because of an interaction between viagra and efavirenz, one of the drugs in Atripla.

    You should speak to your HIV doctor about close monitoring when taking efavirenz and Viagra together and about dose adjustment.

    Sexual dysfunction is common amongst people with HIV. Please read this question which outlines why this happens and what you can do in more detail.

    For information about HIV services in South Africa you could contact TAC who are based in Cape Town but have branches across the country.

  7. Simon Collins

    Hi – please see this link for more information.

  8. mohammed

    My viral load after taking another test after that was 600…the cd4 count was 24.

    I am goin to go for another test at end october to see if viral load is undetected…doctor did say its a possible blip….can i still take meds for erectile dysfunction with atripla….like kamagra gel or tablets which is a generic to viagra


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