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AIDS. 2004 Nov 5;18(16):2185-9.

Antiretroviral resistance and high-risk transmission behavior among HIV-positive patients in clinical care.

Author information

  • 1AIDS Program, Section of Infectious Diseases, Yale University School of Medicine and VA Connecticut Healthcare System, New Haven, Connecticut 06510, USA. Michael.Kozal@yale.edu

Abstract

BACKGROUND:

HIV-positive patients receiving antiretroviral therapy (ART) who engage in HIV transmission behaviors may harbor and transmit drug-resistant HIV. However, little is known about the risk behaviors of these patients, potential partners exposed and the relationship of these to ART resistance.

OBJECTIVE:

To determine the relationship of HIV drug resistance and continuing HIV transmission risk behavior among HIV-positive patients in care.

METHODS:

A retrospective, cross-sectional study of HIV transmission risk behavior and HIV drug resistance data from 333 HIV-positive patients.

RESULTS:

Among a diverse population of 333 HIV-positive patients, 75 (23%) had unprotected sex during the previous 3-months, resulting in 1126 unprotected sexual events with 191 partners of whom 155 were believed by patients to be HIV-negative or of unknown status. Eighteen of the 75 (24%) had resistant HIV and 207 unprotected sexual events, exposing 18% of the HIV- or status unknown partners. There was no difference in the proportion of patients engaging in unprotected sex who had undetectable viral load (VL) (22%): VL > 400 copies/ml without resistance (20%) and VL > 400 copies/ml with resistance (26%). Resistance and risk behavior was predicted only by lower mental health scores (odds ratio, 10.3; 95% confidence interval, 1.7-18.6).

CONCLUSION:

A substantial minority (23%) of patients in clinical care engaged in HIV sexual transmission risk behavior. A small subset of these also had ART-resistant HIV. However, this core group (approximately 5% of all patients) accounted for a large number of high-risk HIV transmission events with resistant virus, exposing a substantial number of partners.

PMID:
15577652
[PubMed - indexed for MEDLINE]
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