title: Sexual risk behavior among youth with perinatal HIV infection in the United States: predictors and implications for intervention development.
abstract: BACKGROUND
  Factors associated with initiation of sexual activity among perinatally human immunodeficiency virus (HIV)-infected (PHIV(+)) youth, and the attendant potential for sexual transmission of antiretroviral (ARV) drug-resistant HIV, remain poorly understood.
  
  
  METHODS
  We conducted cross-sectional and longitudinal analyses of PHIV(+) youth aged 10-18 years (mean, 13.5 years) enrolled in the US-based Pediatric HIV/AIDS Cohort Study between 2007 and 2009. Audio computer-assisted self-interviews (ACASI) were used to collect sexual behavior information.
  
  
  RESULTS
  Twenty-eight percent (95% confidence interval [CI], 23%-33%) (92/330) of PHIV(+) youth reported sexual intercourse (SI) (median initiation age, 14 years). Sixty-two percent (57/92) of sexually active youth reported unprotected SI. Among youth who did not report history of SI at baseline, ARV nonadherence was associated with sexual initiation during follow-up (adjusted hazard ratio, 2.87; 95% CI, 1.32-6.25). Youth living with a relative other than their biological mother had higher odds of engaging in unprotected SI than those living with a nonrelative. Thirty-three percent of youth disclosed their HIV status to their first sexual partner. Thirty-nine of 92 (42%) sexually active youth had HIV RNA ≥5000 copies/mL after sexual initiation. Viral drug resistance testing, available for 37 of these 39 youth, identified resistance to nucleoside reverse transcriptase inhibitors in 62%, nonnucleoside reverse transcriptase inhibitors in 57%, protease inhibitors in 38%, and all 3 ARV classes in 22%.
  
  
  CONCLUSIONS
  As PHIV(+) youth become sexually active, many engage in behaviors that place their partners at risk for HIV infection, including infection with drug-resistant virus. Effective interventions to facilitate youth adherence, safe sex practices, and disclosure are urgently needed.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts 02115, USA. ktassiop@hsph.harvard.edu
authors.forename: Katherine
authors.initials: K
authors.lastname: Tassiopoulos
authors.forename: Anna-Barbara
authors.initials: AB
authors.lastname: Moscicki
authors.forename: Claude
authors.initials: C
authors.lastname: Mellins
authors.forename: Deborah
authors.initials: D
authors.lastname: Kacanek
authors.forename: Kathleen
authors.initials: K
authors.lastname: Malee
authors.forename: Susannah
authors.initials: S
authors.lastname: Allison
authors.forename: Rohan
authors.initials: R
authors.lastname: Hazra
authors.forename: George K
authors.initials: GK
authors.lastname: Siberry
authors.forename: Renee
authors.initials: R
authors.lastname: Smith
authors.forename: Mary
authors.initials: M
authors.lastname: Paul
authors.forename: Russell B
authors.initials: RB
authors.lastname: Van Dyke
authors.forename: George R
authors.initials: GR
authors.lastname: Seage
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use; D002648:Child; D003430:Cross-Sectional Studies; D003617:Dangerous Behavior; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D012307:Risk Factors; D012725:Sexual Behavior; D014481:United States / Q000453:epidemiology; D047568:Unsafe Sex
chemical_list: D019380:Anti-HIV Agents