title: The Bolger conference on PDE-5 inhibition and HIV risk: implications for health policy and prevention.
abstract: BACKGROUND
  Recent reports have linked the use of phosphodiesterase type 5 (PDE-5) inhibitors with increased rates of high-risk sexual behavior and HIV transmission in some individuals.
  
  
  OBJECTIVE
  A National Institute of Mental Health (NIMH)-funded, multidisciplinary conference was convened to evaluate scientific research, clinical and ethical considerations, and public policy implications of this topic.
  
  
  METHODS
  Published and unpublished findings on effects of PDE-5 inhibitors on sexual behavior; published guidelines and management recommendations.
  
  
  METHODS
  Leading investigators in relevant disciplines (e.g., public health, epidemiology, medical ethics, urology, psychology) participated in a 2-day meeting, including representatives of government, scientific, and regulatory agencies (the Centers for Disease Control, Food and Drug Administration, NIMH, and the National Institute on Drug Abuse). Panelists provided critical reviews of substantive areas of research, followed by question and answer sessions on each topic. On the second day, working groups were convened to identify critical gaps and priorities in three major areas: (i) research and evaluation needs; (ii) prevention strategies and clinical management issues; and (iii) policy and prevention implications.
  
  
  RESULTS
  Research needs and priorities were categorized into four specific areas: (i) basic and clinical/laboratory research; (ii) epidemiology and risk factors; (iii) social-behavioral processes and interventions; and (iv) prevention/policy and educational needs. Identified gaps in the available data include populations at risk (e.g., risk among heterosexuals, risk profiles among subpopulations of men who have sex with men) and the specific role of PDE-5 inhibitors in HIV seroconversion. Specific areas of emphasis were the need for safer sex counseling, comprehensive sexually transmitted infection (STI) screening and follow-up when indicated, avoidance of potentially dangerous drug interactions, and potential benefits of testosterone replacement for HIV-positive men with decreased androgen and other symptoms of hypogonadism. Conclusions. A conference was convened on the topic of PDE-5 inhibition and HIV risk. This "white paper" summarizes the findings of the conference and recommendations for future research.
authors.affiliation: Department of Psychiatry, Robert Wood Johnson Medical School, Piscataway, NJ, and New England Research Institutes, Watertown, MA. Electronic address: rrosen@neriscience.com.
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Rosen
authors.affiliation: Center for AIDS Prevention Studies, Department of Medicine, San Francisco, CA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Catania
authors.affiliation: HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY.
authors.forename: Anke A
authors.initials: AA
authors.lastname: Ehrhardt
authors.affiliation: Department of Urology, The Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Burnett
authors.affiliation: Department of Urology, University of California, San Francisco, CA.
authors.forename: Tom F
authors.initials: TF
authors.lastname: Lue
authors.affiliation: Departments of Physiology and Urology, Northwestern University Medical School, Chicago, IL.
authors.forename: Kevin
authors.initials: K
authors.lastname: McKenna
authors.affiliation: Kinsey Institute for Research in Sex, Gender and Reproduction, Indiana University, Bloomington, IN.
authors.forename: Julia R
authors.initials: JR
authors.lastname: Heiman
authors.affiliation: HIV/AIDS Statistics and Epidemiology, San Francisco Public Health Department, San Francisco, CA.
authors.forename: Sandy
authors.initials: S
authors.lastname: Schwarcz
authors.affiliation: David Ostrow & Associates, Lakewood, IL.
authors.forename: David G
authors.initials: DG
authors.lastname: Ostrow
authors.affiliation: Medical and Health Research Association, New York, NY.
authors.forename: Sabina
authors.initials: S
authors.lastname: Hirshfield
authors.affiliation: Prevention Research Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Purcell
authors.affiliation: Departments of Psychology and Obstetrics and Gynecology, University of Western Ontario, London, Ontario, Canada.
authors.forename: William A
authors.initials: WA
authors.lastname: Fisher
authors.affiliation: Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Ron
authors.initials: R
authors.lastname: Stall
authors.affiliation: Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), New York University, New York, NY.
authors.forename: Perry N
authors.initials: PN
authors.lastname: Halkitis
authors.affiliation: Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Latini
authors.affiliation: City University, Institute of Health Sciences, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Elford
authors.affiliation: Department of Sociology, University of Chicago, Chicago, IL.
authors.forename: Edward O
authors.initials: EO
authors.lastname: Laumann
authors.affiliation: Center for Adolescent Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Freya L
authors.initials: FL
authors.lastname: Sonenstein
authors.affiliation: Department of Pharmacology & Experimental Therapeutics, Tufts University, Boston, MA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Greenblatt
authors.affiliation: Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kloner
authors.affiliation: Private Practice, Calgary Alberta, Canada.
authors.forename: Jay
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Medicine, Emory University, Atlanta, GA.
authors.forename: David
authors.initials: D
authors.lastname: Malebranche
authors.affiliation: Kinsey Institute for Research in Sex, Gender and Reproduction, Indiana University, Bloomington, IN.
authors.forename: Erick
authors.initials: E
authors.lastname: Janssen
authors.affiliation: Cesar Chavez Institute, San Francisco State University, San Francisco, CA.
authors.forename: Rafael
authors.initials: R
authors.lastname: Diaz
authors.affiliation: STD Prevention and Control Services, San Francisco Department of Public Health, San Francisco, CA.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Klausner
authors.affiliation: Center for Bioethics, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Caplan
authors.affiliation: Saint Thomas Hospital, London, UK.
authors.forename: Graham
authors.initials: G
authors.lastname: Jackson
authors.affiliation: Department of Urology, Columbia Presbyterian Medical Center, Columbia University, New York, NY.
authors.forename: Ridwan
authors.initials: R
authors.lastname: Shabsigh
authors.affiliation: Medical Consequences Branch, National Institute on Drug Abuse, Bethesda, MD.
authors.forename: Jag H
authors.initials: JH
authors.lastname: Khalsa
authors.affiliation: Center for Mental Health Research on AIDS, National Institute of Mental Health, Bethesda, MD, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Stoff
mesh_terms: D015106:3',5'-Cyclic-GMP Phosphodiesterases / Q000037:antagonists & inhibitors*; D007172:Erectile Dysfunction / Q000188:drug therapy; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006291:Health Policy; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D011322:Primary Prevention / Q000458:organization & administration*; D012309:Risk-Taking; D012736:Sex Education / Q000458:organization & administration; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D012955:Societies, Medical
chemical_list: D015106:3',5'-Cyclic-GMP Phosphodiesterases