Intended for healthcare professionals

Minerva Minerva


BMJ 2000; 321 doi: (Published 19 August 2000) Cite this as: BMJ 2000;321:520

About a third of men infected with HIV have erectile dysfunction, and at least some if them will be taking sildenafil (Viagra). Sildenafil is metabolised by CYP3A4, one of the cytochrome P450 enzymes potently inhibited by two common antiretroviral drugs ritonavir and saquinavir. A paper and a commentary in British Journal of Clinical Pharmacology (2000;50:85, 99-107) say that men infected with HIV should start on a low dose of sildenafil to minimise the risk of side effects such as a drop in blood pressure, flushing, and headaches.

There are already hundreds of studies in a variety of populations showing that moderate consumption of alcohol lowers the risk of dying from cardiovascular disease. Older residents of Dubbo, a small town in New South Wales, are no exception, according to a cohort study in Medical Journal of Australia (2000;173:121-4). Cardiovascular deaths were reduced by half in men and women who had 1–7 drinks a week, but the effect disappeared in men aged over 75.

Britain's silly season for news got under way last week with a front page story in the Times reporting that the NHS was being swamped by a tidal wave of foreigners taking advantage of our “free” health care (August 9). The reporters admit that the …

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