Department of Epidemiology, University of Washington School of Public Health, Seattle, USA.
AIDS. 2012 Nov 28;26(18):2383-91. doi: 10.1097/QAD.0b013e32835ad438.
To evaluate whether HAART is associated with subsequent sexual and drug-related risk behavior compensation among injection drug users (IDUs).
A community-based cohort study of 362 HIV-infected IDUs initiating HAART in Baltimore, Maryland.
HAART use and risk behavior was assessed at 8316 biannual study visits (median 23). Using logistic regression with generalized estimating equations (GEE), we examined the effect of HAART initiation on changes in risk behavior while adjusting for sociodemographics, alcohol use, CD4 cell count, year of initiation and consistency of HAART use.
At HAART initiation, participants were a median of 44.4 years old, 71.3% men and 95.3% African-American. In multivariable analysis, HAART initiation was associated with a 75% reduction in the likelihood of unprotected sex [adjusted odds ratio (aOR) 0.25; 95% confidence interval (CI), 0.19-0.32] despite no change in overall sexual activity (aOR 0.95; 0.80-1.12). Odds of any injecting decreased by 38% (aOR 0.62; 0.51-0.75) after HAART initiation. Among the subset of persistent injectors, needle-sharing increased nearly two-fold (aOR 1.99; 1.57-2.52). Behavioral changes were sustained for more than 5 years after HAART initiation and did not differ by consistency of HAART use. Reporting specific high-risk behaviors in the year prior to initiation was a robust predictor of engaging in those behaviors subsequent to HAART.
Overall, substantial declines in sexual risk-taking and active injecting argue against significant behavioral compensation among IDUs following HAART initiation. These data also provide evidence to support identifying persons with risky pre-HAART behavior for targeted behavioral intervention.
评估高效抗逆转录病毒治疗（HAART）是否与接受治疗的注射吸毒者（IDU）随后的性和药物相关风险行为补偿有关。
这是一项在马里兰州巴尔的摩进行的、基于社区的 362 名感染艾滋病毒的 IDU 队列研究，这些 IDU 开始接受 HAART。
在 8316 次每两年一次的研究访问中（中位数为 23 次），评估 HAART 的使用情况和风险行为。使用广义估计方程（GEE）的逻辑回归，我们在调整社会人口统计学因素、酒精使用、CD4 细胞计数、开始时间和 HAART 使用一致性的情况下，检查 HAART 开始对风险行为变化的影响。
在开始 HAART 时，参与者的年龄中位数为 44.4 岁，71.3%为男性，95.3%为非裔美国人。在多变量分析中，尽管总体性行为没有变化（调整后的优势比[aOR]0.95；0.80-1.12），但 HAART 开始与无保护性行为的可能性降低 75%相关（调整后的比值比[aOR]0.25；0.19-0.32）。开始 HAART 后，任何注射的可能性降低了 38%（aOR 0.62；0.51-0.75）。在持续注射者亚组中，针头共享增加了近两倍（aOR 1.99；1.57-2.52）。HAART 开始后 5 年以上，行为变化持续存在，且与 HAART 使用的一致性无关。在开始之前的一年中报告特定的高风险行为是随后从事这些行为的有力预测指标。
总体而言，性冒险行为和主动注射行为的大量减少表明，接受 HAART 治疗的 IDU 并没有出现显著的行为补偿。这些数据还为识别有高风险行为的人提供了证据，以便对他们进行有针对性的行为干预。
