To the Editor: The Commentary by Dr Jaffe and colleagues1 addressed the reemerging human immunodeficiency virus (HIV) epidemic among men who have sex with men in the United States. The authors describe substance abuse, particularly methamphetamines and alcohol, as one of the factors that contribute to unsafe sexual behaviors. Important substances of abuse that were not mentioned in the Commentary are phosphodiesterase type-5 inhibitors: sildenafil, vardenafil, and tadalafil. Phosphodiesterase type-5 inhibitors are indicated for the treatment of impotence but can enhance erectile function in the absence of clinical impotence and are often used in combination with other recreational drugs.2
Hulgan T, Klausner JD. Phosphodiesterase Type-5 Inhibitors and the Reemerging HIV Epidemic. JAMA. 2008;299(12):1426. doi:10.1001/jama.299.12.1426
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