Kravcik S, Victor G, Houston S, Sutherland D, Garber G E, Hawley-Foss N, Angel J B, Cameron D W
Division of General Medicine, Ottawa General Hospital, Ontario, Canada.
J Acquir Immune Defic Syndr Hum Retrovirol. 1998 Oct 1;19(2):124-9. doi: 10.1097/00042560-199810010-00004.
Dramatic reductions in plasma HIV RNA levels are possible with current antiretroviral regimens; the effect of potent therapies and "undetectable" viral load on the perceived risk of HIV transmission and need for safer practices remains unknown.
A questionnaire was developed to examine perceptions of HIV transmission risk and need for safer practices with unprotected anal, vaginal, and oral sex and intravenous drug use with needle sharing for HIV-discordant couples in which the HIV-infected partner was receiving no therapy, was receiving reverse transcriptase inhibitor therapy, and protease inhibitor (PI)-based therapy with viral load "undetectable". This was applied anonymously to 147 unselected HIV-infected individuals attending a university-based HIV clinic.
Almost all respondents believed that all sexual activities except oral sex were "very risky" and that safer practices were "extremely important" for those not receiving antiretroviral agents. Significantly fewer considered that anal or vaginal sex was "very risky" for those receiving PI therapy (90.9% and 86.0%, respectively), and fewer thought that safer practices for anal or vaginal sex were "very important" for those receiving PI therapy (93.0% and 91.6%, respectively). In total, 20.4% thought the risk of HIV transmission for at least one activity was reduced for those receiving PI therapy, and 19.0% believed that the need for safer practices was reduced by PI therapy.
A small but significant proportion of HIV-infected people perceive the need for safer practices to be reduced during antiretroviral therapy, particularly those containing PIs. Even if the risk is truly reduced, the importance of safer practices should be conveyed consistently and terms such as "undetectable" to describe HIV RNA responses should be avoided.
目前的抗逆转录病毒疗法可使血浆中HIV RNA水平显著降低；强效疗法及“检测不到”的病毒载量对人们所感知的HIV传播风险及采取更安全行为的必要性的影响尚不清楚。
设计了一份问卷，以调查HIV血清学不一致的伴侣（其中HIV感染伴侣未接受治疗、接受逆转录酶抑制剂治疗以及接受基于蛋白酶抑制剂（PI）且病毒载量“检测不到”的治疗）对于无保护肛交、阴道性交、口交以及共用针头静脉注射毒品时HIV传播风险的认知以及采取更安全行为的必要性。该问卷以匿名方式应用于147名来自一所大学HIV门诊的未经挑选的HIV感染者。
几乎所有受访者都认为，除口交外的所有性行为“风险非常高”，且对于未接受抗逆转录病毒药物治疗的人来说，采取更安全的行为“极其重要”。对于接受PI治疗的人，认为肛交或阴道性交“风险非常高”的比例显著降低（分别为90.9%和86.0%），且认为肛交或阴道性交采取更安全行为“非常重要”的比例也降低了（分别为93.0%和91.6%）。总体而言，20.4%的人认为接受PI治疗的人至少有一种行为的HIV传播风险降低了，19.0%的人认为PI治疗降低了采取更安全行为的必要性。
一小部分但比例显著的HIV感染者认为在抗逆转录病毒治疗期间采取更安全行为的必要性降低了，尤其是那些包含PI的治疗。即使风险确实降低了，也应始终传达采取更安全行为的重要性，并应避免使用“检测不到”等术语来描述HIV RNA反应。
