Antiretroviral resistance and high-risk transmission behavior among HIV-positive patients in clinical care
Antiretroviral resistance and high-risk transmission behavior among HIV-positive patients in clinical care
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DOI：
10.1097/00002030-200411050-00011
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发表时间：
2004-11-05
期刊：
影响因子：
3.8
通讯作者：
Friedland, G
中科院分区：
文献类型：
--
作者：
Kozal, MJ;Amico, KR;Friedland, G
背景资料：接受抗逆转录病毒治疗（ART）的艾滋病毒阳性患者如果有艾滋病毒传播行为，可能会携带和传播耐药艾滋病毒。然而，对这些患者的危险行为、潜在性伴暴露以及这些与抗逆转录病毒疗法耐药的关系知之甚少。目的：确定艾滋病病毒（HIV）阳性患者在护理中的HIV耐药与HIV持续传播危险行为的关系。方法：对333例HIV阳性患者的HIV传播危险行为和HIV耐药数据进行回顾性横断面研究。在333例HIV阳性患者的不同人群中，75例（23%）在过去3个月内发生了无保护性行为，导致与191名伴侣发生了1126次无保护性行为，其中155名患者认为是HIV阴性或状态不明。75人中有18人（24%）对艾滋病毒有抵抗力，207次无保护的性行为，暴露了18%的艾滋病毒感染者或身份不明的性伙伴。无保护性行为的患者中病毒载量（VL）检测不到的比例（22%）没有差异：VL > 400拷贝/ml无耐药性（20%）和VL > 400拷贝/ml有耐药性（26%）。抵抗和危险行为的预测只有较低的心理健康评分（比值比，10.3; 95%置信区间，1.7-18.6）。结论：一个相当少的（23%）的患者在临床护理从事艾滋病毒性传播的危险行为。其中一小部分人也有抗逆转录病毒疗法的艾滋病毒。然而，这一核心群体（约占所有患者的5%）占大量具有耐药病毒的高风险艾滋病毒传播事件，暴露了大量的伴侣。(C)2004年利平科特威廉姆斯威尔金斯。
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).Conclusion: 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. (C) 2004 Lippincott Williams Wilkins.