Sexual dysfunction is a bothersome side effect of several medications, though it has not yet been reported with the use of ledipasvir/sofosbuvir for the treatment of hepatitis C. However, sexual dysfunction is a potentially unrecognized side effect of ledipasvir/sofosbuvir that could result in nonadherence and treatment failure. We report a case of a 42-year-old man with a sudden onset of sexual dysfunction with the initiation of ledipasvir/sofosbuvir for the treatment of hepatitis C. The patient had no prior history or risk factors for the development of sexual dysfunction. His symptoms resolved upon discontinuation of ledipasvir/sofosbuvir after a successful 12-week course. Clinicians should be aware that sexual dysfunction is a possible side effect of ledipasvir/sofosbuvir and educate patients appropriately. Adherence should be emphasized as the risks of untreated hepatitis C virus far outweigh transient sexual dysfunction.
CunninghamGRRosenRC. Overview of male sexual dysfunction. In: SynderPJO’LearyMP, ed. UpToDate [database online]. Waltham, MA: Wolters Kluwer; 2004. http://www.uptodate.com. Updated August 16, 2017. Accessed March 1, 2017.
3.
HunterSSGadallahAAzawiMK. Erectile dysfunction in patients with chronic hepatitis C virus infection. Arab J Gastroenterol. 2014;15(1):16–20.
4.
ChungSKellerJLiangY. Association between viral hepatitis and erectile dysfunction: a population-based case-control analysis. J Sex Med. 2012;9(5):1295–1302.
5.
MillerTA. Diagnostic evaluation of erectile dysfunction. Am Fam Physician. 2000;61(1):95–104.
6.
Abdel HafezKKamelSAbdel AalA. The impact of interferon therapy on the sexual function of hepatitis C male patients. J Sex Med. 2015;12(suppl 1):8–9.
7.
BunnellKVibhakarSGlowackiR. Nephrotoxicity associated with concomitant use of ledipasvir-sofosbuvir and tenofovir in a patient with hepatitis C virus and human immunodeficiency virus coinfection. Pharmacotherapy. 2016;36(9):e148–e153.
8.
CarlierCKheloufiFBerdugoJ. Self-reporting of adverse drug reactions by patients treated with direct antiviral agents for chronic hepatitis C compared to adverse drug reactions reported in medical records. Fundam Clin Pharmacol. 2016;30(suppl 1):25.
9.
ChuechLSChungSDHuangCY. Hepatitis and the risk of erectile dysfunction: a population-based case-control study. J Urol. 2012;187(4 suppl 1):e333.
10.
ChungSDChenYKKangJH. Population-based estimates of medical comorbidities in erectile dysfunction in a Taiwanese population. J Sex Med. 2011;8(12):3316–3324.
11.
DanoffAKhanOWanDW. Sexual dysfunction is highly prevalent among men with chronic hepatitis C virus infection and negatively impacts health-related quality of life. Am J Gastroenterol. 2006;101(6):1235–1243.
12.
DebesJRicciP. Acute liver failure during hepatitis C treatment with sofosbuvir and ledipasvir. Dig Liver Dis. 2015;47(12):1091–1092.
13.
DoveLMRosenRCRamcharranD. Decline in male sexual desire, function, and satisfaction during and after antiviral therapy for chronic hepatitis C. Gastroenterology. 2009;137(3):873–884.
14.
DurazzoMPremoliADi BisceglieC. Male sexual disturbances in liver diseases: what do we know?J Endocrinol Invest. 2010;33(7):501–505.
15.
El-AtrebiKEl-AtrebiMEl-BassyouniH. Sexual dysfunction in males with chronic hepatitis C virus: relevance to histopathologic changes and peginterferon treatment. Saudi J Gastroenterol. 2011;17(6):406–410.
16.
El-SerafiATOsamaSEl-ZalatH. Dysregulation of male sex hormones in chronic hepatitis C patients. Andrologia. 2016;48(1):82–86.
17.
ElshimiEMoradWMohamadNE. Female sexual dysfunction among Egyptian patients with chronic hepatitis C. J Sex Med. 2014:11(3):768–775.
18.
FabregasBCMouraASde AvilaRE. Sexual dysfunction and dissatisfaction in chronic hepatitis C patients. Rev Soc Bras Med Trop. 2014;47(5):564–572.
19.
FazelYLamBGolabiP. Safety analysis of sofosbuvir and ledipasvir for treating hepatitis C. Expert Opin Drug Saf. 2015;14(8):1317–1326.
20.
FerriCBertozziMAZignegoAL. Erectile dysfunction and hepatitis C virus infection. J Am Med Assoc. 2002;288(6):698–699.
21.
FosterGR. Quality of life considerations for patients with chronic hepatitis C. J Viral Hepat. 2009;16(9):605–611.
22.
FuscoFD’AnzeoGRossiA. Erectile dysfunction in patients with chronic viral hepatitis: a systematic review of the literature. Exp Opin Pharmacother. 2013;14(18):2533–2544.
23.
GuoPWangYWangL. Erectile dysfunction in living donor kidney transplant recipients associated with chronic hepatitis b infection. Transplan Proc. 2010;42(7):2556–2559.
HungSFChungSLinH. Comorbidity profiles among patients with erectile dysfunction: a nationwide population-based study. Urology. 2011;78(3 suppl 1):358–359.
26.
HuygheEKamarNWagnerF. Erectile dysfunction in end-stage liver disease men. J Sex Med. 2009;6(5):1395–1401.
27.
KrausMRSchaferABentinkT. Sexual dysfunction in males with chronic hepatitis C and antiviral therapy: interferon-induced functional androgen deficiency or depression?J Endocrinol. 2005;185(2):345–352
28.
Ledipasvir + sofosbuvir (Harvoni). A therapeutic advance in genotype 1 hepatitis C virus infection, despite uncertainties. Prescrire Int. 2015;24(166):285–289.
29.
MalaguarneraMVicariECalogeroA. Sexual dysfunction in chronic hepatitis C virus patients treated with interferon alpha and ribavirin. J Interferon Cytokine Res. 2008;28(10):603–609.
30.
MutoTFukuiSIwabuchiS. Influence of interferon therapy on sex hormones in patients with chronic hepatitis C. Acta Hepatologica Japonica. 1997;38(4):207–212.
31.
NazFBawanyAKhahroAA. Sexual dysfunction in patients with chronic liver disease. Hepatol Int. 2014;8(1 suppl 1):299.
32.
PadegimasAFordeKGoldbergL. Myo-pericarditis secondary to ledipasvir-sofosbuvir therapy. J Hepatol. 2016;64(5):1196–1198.
33.
PatelSTrakrooSSanakaS. Severe myositis with the use of sofosbuvir/ledipasvir for hepatitis c infection: a case of unexpected interactions. Am J Gastroenterol. 2015;110(suppl 1):333.
34.
PiazzaMTosoneGBorgiaG. Long-term interferon-α therapy does not affect sex hormones in males with chronic hepatitis C. J Interferon Cytokine Res. 1997;17(9):525–529.
35.
RaoJDanoffABiniEJ. Elevated sex hormone binding globulin levels may contribute to sexual dysfunction in men with chronic hepatitis C virus infection. J Clin Gastroenterol. 2009;43(1):94–95.
36.
ScottGRiegerK. New-onset cutaneous lichen planus following therapy for hepatitis C with ledipasvir-sofosbuvir. J Cutan Pathol. 2016;43(4):408–409.
37.
SilvaLDDa CunhaLRAraujoRF. Influence of psychiatric disorders in the quality of life of patients with chronic hepatitis C. Hepatology. 2011(54 suppl 1):1190A–1191A.
38.
SimsekIAslanGAkarsuM. Assessment of sexual functions in patients with chronic liver disease. Int J Impot Res. 2005;17(4):343–345.
39.
SoykanABoztasHIdilmanR. Sexual dysfunctions in HCV patients and its correlations with psychological and biological variables. Int J Impot Res. 2005;17(2):175–179.
40.
TekinRBulutMYilmazA. Assessment sexual dysfunction in chronic hepatitis B patients. Hepatol Int. 2017;11(1 suppl 1):655.
41.
TodaKMiwaYKuriyamaS. Erectile dysfunction in patients with chronic viral liver disease: its relevance to protein malnutrition. J Gastroenterol. 2005;40(9):894–900.
42.
VergniolJDucSHouG. Sexual quality of life is impaired in patients with chronic hepatitis C. Int J Impot Res. 2016(28):68–73.
43.
WanchooRThakkarJSchwartzD. Harvoni (ledipasvir with sofosbuvir)-induced renal injury. Am J Gastroenterol. 2016;111(1):148–149.
44.
WuWCChungSDChiuKM. Medical comorbidity associated with erectile dysfunction: a population based study. J Sex Med. 2012;9(suppl 2):122.
