Kozal Michael J, Amico K Rivet, Chiarella Jennifer, Schreibman Tanya, Cornman Deborah, Fisher William, Fisher Jeffrey, Friedland Gerald
AIDS Program, Section of Infectious Diseases, Yale University School of Medicine and VA Connecticut Healthcare System, New Haven, Connecticut 06510, USA.
AIDS. 2004 Nov 5;18(16):2185-9. doi: 10.1097/00002030-200411050-00011.
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.
To determine the relationship of HIV drug resistance and continuing HIV transmission risk behavior among HIV-positive patients in care.
A retrospective, cross-sectional study of HIV transmission risk behavior and HIV drug resistance data from 333 HIV-positive patients.
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).
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.
接受抗逆转录病毒治疗（ART）的HIV阳性患者若有HIV传播行为，可能携带并传播耐药性HIV。然而，对于这些患者的风险行为、潜在暴露的伴侣以及这些与ART耐药性的关系，我们知之甚少。
确定接受治疗的HIV阳性患者中HIV耐药性与持续的HIV传播风险行为之间的关系。
对333例HIV阳性患者的HIV传播风险行为和HIV耐药性数据进行回顾性横断面研究。
在333例不同的HIV阳性患者中，75例（23%）在过去3个月内有未采取保护措施的性行为，导致1126次未采取保护措施的性接触，涉及191名伴侣，其中患者认为155名伴侣为HIV阴性或状况不明。75例中有18例（24%）携带耐药性HIV，发生了207次未采取保护措施的性接触，使18%的HIV阴性或状况不明的伴侣暴露于风险中。病毒载量（VL）不可检测的患者中，有未采取保护措施性行为的比例（22%）与VL>400拷贝/ml且无耐药性的患者（20%）以及VL>400拷贝/ml且有耐药性的患者（26%）之间没有差异。仅较低的心理健康评分可预测耐药性和风险行为（优势比，10.3；95%置信区间，1.7 - 18.6）。
接受临床治疗的患者中，相当一部分少数（23%）有HIV性传播风险行为。其中一小部分患者还携带对ART耐药的HIV。然而，这一核心群体（约占所有患者的5%）导致了大量携带耐药病毒的高风险HIV传播事件，使大量伴侣暴露于风险中。
