NEW YORK (Reuters Health) - The transmission of drug-resistant HIV among intravenous drug users (IDUs) who participate in high-risk behaviors is high, according to a new study. In addition, such drug users were often prescribed less effective and not recommended regimens.
“Evidence of increasing prevalence of drug resistance among recent HIV seroconverters indicates a growing public health concern and warrants an examination of the problems from a prevention perspective,” Dr. Ajay K. Sethi, of Case Western Reserve University School of Medicine, Cleveland, Ohio, and colleagues write in the April issue of the Journal of Acquired Immune Deficiency Syndromes.
The researchers examined predictors of unprotected sex and needle sharing among 638 HIV-infected drug users who completed 2731 visits between 1996 and 2000 in an ongoing cohort study in Baltimore, Maryland. They classified the subjects as being at higher or lower risk of HIV and of drug-resistant HIV transmission based on viral load, antiretroviral therapy use, and reported high-risk behavior.
“After taking account other factors, HIV-infected individuals were significantly more likely to engage in unprotected sex if their sexual partners were also HIV-infected (p < 0.001),” Dr. Sethi said in an interview with Reuters Health. “Also, HIV-infected women were twice as likely as men to report unprotected sex (p < 0.001).”
Among IDUs who had injected recently, there was an independent association between sharing needles and homelessness (p = 0.002), daily injection (p = 0.001), and trading sex for drugs (p < 0.001). “IDUs were at higher risk of HIV and drug-resistant HIV transmission at 19% and 6% of all visits, respectively,” the investigators write. Among subjects who were at high risk of HIV transmission, significant drug-resistant HIV was found at 14% of visits.
“Although HAART was widely available during the study period, less effective and not recommended regimens were prescribed to nearly half of IDUs who were potential transmitters of drug-resistant HIV,” Dr. Sethi told Reuters Health. “Transmission of resistance is one consequence of continued wide-use of non-HAART regimens.”
“It is likely that reducing high-risk behaviors by HIV-infected individuals would reduce the transmission of HIV, including drug-resistant HIV, to uninfected individuals,” Dr. Sethi said. “Clinicians can play an important role by counseling HIV-infected patients about the importance of reducing high-risk behaviors.”
In addition, he added, “access to clean needles, which has already been associated with less needle sharing and reduced transmission of HIV, would also reduce the risk of drug-resistant HIV transmission.”
Source: J Acquir Immune Defic Syndr 2004;35:503-510. [ Google search on this article ]
MeSH Headings:Biological Phenomena: Biological Phenomena, Cell Phenomena, and Immunity: Biological Sciences: Biology: Drug Resistance, Microbial: Genetics: Genetics, Microbial: Microbiologic Phenomena: Pharmacogenetics: Risk-Taking: Biological SciencesCopyright © 2002 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.
