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Session 115
Poster Abstracts Risk Behavior Tuesday, 1:30 - 3:30 pm Poster Hall |
Background: The substantial frequency of drug resistance in persons recently infected with HIV implies exposure among HIV-uninfected individuals to HIV-infected persons with drug-resistant virus. While there is an increasing emphasis on understanding high-risk behavior among HIV-infected patients in general, little work has focused on those with drug-resistant virus.
Methods: We examined HAART-treated patients in the Study of the Consequences of the Protease Inhibitor Era
(SCOPE), a clinic-based cohort of HIV-infected adults. Sexual behavior was
ascertained by self-administered questionnaire. Genotypic drug
resistance testing was performed on patients with viral load >100 RNA
copies/mL.
Results: Among 287 patients on HAART, 177 had viral load >100 copies/mL; 168 (95%) of these had resistance to at least one drug. The prevalence of high-risk sexual behavior in the prior 4 months in the drug-resistant viremia group was comparable to those with either viral load <100 copies/mL or with >100 copies/mL with wild type viremia (see the table). In a multivariable logistic model of predictors of unprotected anal or vaginal sex with a HIV-uninfected or status unknown partner, among the 168 patients with drug-resistant viremia there was strong evidence for an effect of age £35 (OR 8.8, p <0.01), depression (OR 3.4, p <0.05), and sildenafil use (OR 5.4, p <0.01), moderate evidence for lower education (OR 9.2, p = 0.09), alcohol use (OR 4.3, p = 0.12) and use of poppers, ecstasy, metamphetamines, or GHB (OR 2.9, p = 0.06) but no evidence for sexual orientation or adherence (p > 0.15).
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Drug-resistant Viremia |
Undetectable Viral Load or Wild Type Viremia |
p |
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Homosexual
men |
n =
133 |
% |
n =
93 |
% |
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Any unprotected anal sex |
36/133 |
27 |
29/93 |
31 |
0.50 |
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Any unprotected anal sex
with HIV-negative/unknown partner |
23/133 |
17 |
12/93 |
13 |
0.37 |
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Heterosexual
men and women |
n =
35 |
% |
n =
26 |
% |
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Any unprotected vaginal or
anal sex |
6/35 |
17 |
6/26 |
23 |
0.56 |
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Any unprotected vaginal or
anal sex with HIV negative/unknown partner |
2/35 |
6 |
4/26 |
15 |
0.21 |
Conclusions: Among HIV-infected patients with drug-resistant viremia, there is a substantial prevalence of high-risk sex with HIV-uninfected partners. This frequency of high-risk behavior is comparable with other treated patients (most of whom have undetectable viral load), suggesting that a potentially significant group of transmitters is not being systematically identified for direct intervention. The presence of definable risk factors for unsafe sex suggests a role for targeted rather than broad intervention, particularly when resources are limited.
Keywords: Sex Behavior; Drug Resistance; Risk-Taking