Changes in sexual and drug-related risk behavior following antiretroviral therapy initiation among HIV-infected injection drug users.
OBJECTIVE
To evaluate whether HAART is associated with subsequent sexual and drug-related risk behavior compensation among injection drug users (IDUs).


METHODS
A community-based cohort study of 362 HIV-infected IDUs initiating HAART in Baltimore, Maryland.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Department of Epidemiology, University of Washington School of Public Health, Seattle, USA.
Tsung-chieh
TC
Fu
Ryan P
RP
Westergaard
Bryan
B
Lau
David D
DD
Celentano
David
D
Vlahov
Shruti H
SH
Mehta
Gregory D
GD
Kirk
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015142:Baltimore / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003153:Community Health Services; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D016485:Needle Sharing / Q000523:psychology / Q000706:statistics & numerical data*; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000523:psychology; D013997:Time Factors; D047568:Unsafe Sex / Q000706:statistics & numerical data*; D019562:Viral Load; D016903:Drug Monitoring