title: High-risk sexual behavior in adults with genotypically proven antiretroviral-resistant HIV infection.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, University of California at San Francisco and San Francisco General Hospital, San Francisco, CA, USA. pvch@itsa.ucsf.edu
authors.forename: Peter V
authors.initials: PV
authors.lastname: Chin-Hong
authors.forename: Steven G
authors.initials: SG
authors.lastname: Deeks
authors.forename: Teri
authors.initials: T
authors.lastname: Liegler
authors.forename: Elilta
authors.initials: E
authors.lastname: Hagos
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Krone
authors.forename: Robert M
authors.initials: RM
authors.lastname: Grant
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Martin
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000437:Alcoholism; D019380:Anti-HIV Agents / Q000494:pharmacology*; D003863:Depression; D024882:Drug Resistance, Viral; D005260:Female; D006678:HIV / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D015658:HIV Infections / Q000523:psychology* / Q000635:transmission / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016485:Needle Sharing; D010879:Piperazines; D010949:Plasma / Q000821:virology; D011687:Purines; D012367:RNA, Viral / Q000235:genetics; D012309:Risk-Taking; D000068677:Sildenafil Citrate; D013450:Sulfones; D011795:Surveys and Questionnaires; D047568:Unsafe Sex
chemical_list: D019380:Anti-HIV Agents; D010879:Piperazines; D011687:Purines; D012367:RNA, Viral; D013450:Sulfones; D000068677:Sildenafil Citrate