From Medscape General Medicine

eJIAS: eJournal of the International AIDS Society

A Population-Based and Longitudinal Study of Sexual Behavior and Multidrug-Resistant HIV Among Patients in Clinical Care

Posted 06/13/2006

Michael J. Kozal, MD; K. Rivet Amico, PhD; Jennifer Chiarella; Deborah Cornman, PhD, William Fisher, PhD; Jeffrey Fisher, PhD; Gerald Friedland, MD
Author Information

Abstract

Background: Population-based and longitudinal information regarding sexual risk behavior among patients with multidrug resistant (MDR) HIV and their sexual partners is of great public health and clinical importance.
Objective: To characterize the HIV sexual risk behaviors of patients with and without drug-resistant HIV in the clinical care setting over time.
Measurements: 393 HIV-positive patients completed questionnaires of self-reported sexual risk behaviors at approximate 6-month intervals extending over 24 months. HIV viral load and genotypic drug resistance obtained during the same time points were matched to the behavioral data. Multidrug resistance was defined as having resistance to 2 or 3 antiretroviral (ARV) drug classes.
Results: In serial cross-sectional analyses, 393 patients (44% female and 79% heterosexual) contributed 919 matched behavioral and virologic results over the 24 months of data collection. Of these, 250 patients (64%) reported having sex during at least 1 survey period resulting in greater than 10,000 sexual events with more than 1000 partners. Unprotected sexual behavior was reported by 45% of sexually active patients, resulting in 34% of all sex events that exposed 29% of all partners. Of these patients with unprotected sexual events, 31% had HIV drug resistance -- 11.6% with resistance to 2 classes of ARVs (2-class), and 1.8% with 3-class ARV resistance at the time of a sexual risk event. Close to 1000 or 28% of all unprotected sexual events involved resistant strains (11% of these with resistance to 2 classes and 0.2% with 3-class resistance, exposing 20% of unprotected sexual partners to resistant HIV (8% to 2-class and 0.6% to 3-class resistance).

In longitudinal analysis among the 78 patients who reported a cumulative total of 12 months of sexual history and had resistance testing, 38% reported engaging in unprotected sexual behavior. There was substantial and complex variation in the distribution of unprotected sexual events and in the detection of resistance over time.
Conclusion: In this study of HIV sexual risk and resistance over time among HIV-infected patients in clinical care, a substantial proportion engaged in unprotected sex and had drug-resistant HIV, frequently exposing partners to 1- or 2-class resistant HIV strains. However, relatively few exposures involved 3-class resistance. The dynamics of sexual risk behavior and HIV drug resistance are complex and vary over time and urgently require both general and targeted interventions to reduce transmission of resistant HIV.

Readers are encouraged to respond to George Lundberg, MD, Editor of MedGenMed, for the editor's eye only or for possible publication via email: glundberg@medscape.net

 
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Author Information

Michael J. Kozal, MD, Associate Professor of Medicine, Yale University School of Medicine and Acting Chief of Infectious Diseases, VA CT Healthcare System, New Haven, Connecticut

K. Rivet Amico, PhD, Affiliate, Center for Health/HIV Intervention & Prevention, University of Connecticut, Storrs, Connecticut

Jennifer Chiarella, BS, Research Assistant, AIDS Program Yale University, New Haven, Connecticut

Deborah Cornman, PhD, Associate Director, Center for Health/HIV Intervention & Prevention, University of Connecticut, Storrs, Connecticut

William Fisher, PhD, Professor, Department of Psychology and Department of Obstetrics and Gynecology, University of Western Ontario, London, Ontario, Canada

Jeffrey Fisher, PhD, Professor of Psychology; Director, Center for Health/HIV Intervention & Prevention (CHIP), University of Connecticut, Storrs, Connecticut

Gerald Friedland, MD, Professor of Medicine, Epidemiology and Public Health, AIDS Program, Yale New Haven Hospital, Yale School of Medicine, New Haven Connecticut

Disclosure: Michael J. Kozal, MD, has disclosed no relevant financial relationships.

Disclosure: K. Rivet Amico, PhD, has disclosed no relevant financial relationships.

Disclosure: Jennifer Chiarella, has disclosed no relevant financial relationships.

Disclosure: Deborah Cornman, PhD, has disclosed no relevant financial relationships.

Disclosure: William Fisher, PhD, has disclosed no relevant financial relationships.

Disclosure: Jeffrey Fisher, PhD, has disclosed no relevant financial relationships.

Disclosure: Gerald Friedland, MD, has disclosed no relevant financial relationships.

Medscape General Medicine.  2006;8(2):72.  ©2006 Medscape

 
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