title: Antiretroviral resistance and high-risk transmission behavior among HIV-positive patients in clinical care.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To determine the relationship of HIV drug resistance and continuing HIV transmission risk behavior among HIV-positive patients in care.
  
  
  METHODS
  A retrospective, cross-sectional study of HIV transmission risk behavior and HIV drug resistance data from 333 HIV-positive patients.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: AIDS Program, Section of Infectious Diseases, Yale University School of Medicine and VA Connecticut Healthcare System, New Haven, Connecticut 06510, USA. Michael.Kozal@yale.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kozal
authors.forename: K Rivet
authors.initials: KR
authors.lastname: Amico
authors.forename: Jennifer
authors.initials: J
authors.lastname: Chiarella
authors.forename: Tanya
authors.initials: T
authors.lastname: Schreibman
authors.forename: Deborah
authors.initials: D
authors.lastname: Cornman
authors.forename: William
authors.initials: W
authors.lastname: Fisher
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Fisher
authors.forename: Gerald
authors.initials: G
authors.lastname: Friedland
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents; D023241:Antiretroviral Therapy, Highly Active; D001727:Bisexuality; D003430:Cross-Sectional Studies; D024921:Drug Resistance, Multiple, Viral; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology / Q000635:transmission*; D006801:Humans; D008297:Male; D008603:Mental Health; D016017:Odds Ratio; D015995:Prevalence; D012189:Retrospective Studies; D012306:Risk; D047568:Unsafe Sex
chemical_list: D019380:Anti-HIV Agents