Chin-Hong Peter V, Deeks Steven G, Liegler Teri, Hagos Elilta, Krone Melissa R, Grant Robert M, Martin Jeffrey N
Department of Medicine, University of California at San Francisco and San Francisco General Hospital, San Francisco, CA, USA.
J Acquir Immune Defic Syndr. 2005 Dec 1;40(4):463-71. doi: 10.1097/01.qai.0000162238.93988.0c.
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. Although there is an increasing emphasis on understanding high-risk behavior among HIV-infected patients, little work has focused on those with drug-resistant virus.
We examined antiretroviral-treated patients with drug resistance in the Study of the Consequences of the Protease Inhibitor Era, a clinic-based cohort of HIV-infected adults. Sexual behavior was ascertained by self-administered questionnaire. Genotypic antiretroviral resistance testing was performed on isolates from participants with a plasma HIV RNA level > or =100 copies/mL.
Among 279 participants on antiretroviral therapy, 168 (60%) had genotypic resistance to at least 1 drug. In those with drug resistance, 27% of men who have sex with men (MSM) and 11% of heterosexual men and women reported at least 1 episode of unprotected penile-anal or penile-vaginal intercourse in the previous 4 months; 17% of MSM and 6% of heterosexual participants reported unprotected intercourse with an HIV-uninfected or status unknown partner. In a multivariable model of predictors of unprotected anal or vaginal intercourse with an HIV-uninfected or status unknown partner, there was strong evidence for an effect of younger age, depression, and sildenafil use and moderate evidence for frequent alcohol use.
Among HIV-infected patients with drug-resistant viremia, there is a substantial prevalence of high-risk sex with HIV-uninfected partners. The presence of definable risk factors for unsafe sex suggests a role for targeted rather than broad intervention, particularly when resources are limited.
近期感染艾滋病毒的人群中耐药情况相当普遍，这意味着未感染艾滋病毒的个体接触到了携带耐药病毒的艾滋病毒感染者。尽管越来越重视了解艾滋病毒感染患者的高危行为，但针对携带耐药病毒者的研究却很少。
在蛋白酶抑制剂时代后果研究中，我们对接受抗逆转录病毒治疗且有耐药性的患者进行了检查，该研究是一个以诊所为基础的艾滋病毒感染成年人群体。通过自我填写问卷确定性行为情况。对血浆艾滋病毒RNA水平≥100拷贝/毫升的参与者的分离株进行基因型抗逆转录病毒耐药性检测。
在279名接受抗逆转录病毒治疗的参与者中，168名（60%）对至少一种药物有基因型耐药性。在有耐药性的人群中，27%的男男性行为者（MSM）以及11%的异性恋男性和女性报告在过去4个月中至少有一次无保护的阴茎-肛门或阴茎-阴道性交；17%的男男性行为者和6%的异性恋参与者报告与未感染艾滋病毒或感染状况不明的伴侣有无保护性交。在与未感染艾滋病毒或感染状况不明的伴侣进行无保护肛门或阴道性交的预测因素多变量模型中，有充分证据表明年龄较小、抑郁和使用西地那非有影响，有中等证据表明频繁饮酒有影响。
在携带耐药病毒血症的艾滋病毒感染患者中，与未感染艾滋病毒的伴侣进行高危性行为的情况相当普遍。存在可明确的不安全性行为风险因素表明针对性而非广泛干预有作用，特别是在资源有限时。
