icon_folder.gif   Conference Reports for NATAP  
 
  14th HIV Drug resistance Workshop
June 7-11, 2005
Quebec City, Quebec, Canada
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Methamphetamine and Sildenafil (Viagra) use are Associated with High-Risk Sexual Behavior with HIV-uninfected Partners & Transmission of HIV Drug Resistance
 
  ...public health initiatives are needed to address the transmission of HIV drug resistance...
 
"Methamphetamine use is associated with ongoing high-risk sexual behaviours among HIV-infected individuals with drug-resistant virus"
 
PV Chin-Hong1, SG Deeks1, T Liegler 2, MR Krone1, RM Grant1,2, FM Hecht1, E Vittinghoff 1, TJ Coates3 and JN Martin1
 
1University of California at San Francisco, San Francisco, CA, USA 2Gladstone Institute of Virology and Immunology, San Francisco, CA, USA 3University of California at Los Angeles, Los Angeles, CA, USA
 
OBJECTIVES: Recent reports highlight methamphetamine use as a potential contributor to sexual transmission of drug-resistant HIV. We prospectively evaluated methamphetamine use as an independent risk factor of unsafe sex with HIV-uninfected or status unknown partners (USUN) by HIV-infected individuals with genotypicalally confirmed drug resistance.
 
METHODS: We examined subjects in the Study of the Consequences of the Protease Inhibitor Era (SCOPE), a clinic-based cohort of HIV-infected adults in San Francisco. We analysed subjects with HIV RNA >100 copies/ml on antiretroviral therapy who had genotypical evidence of ≥1 resistance-conferring mutation.
 
We ascertained drug use and sexual behaviour by self-administered questionnaire at each 4-month follow-up visit. We defined high-risk sex as unprotected penile-anal or penile-vaginal intercourse with HIV uninfected or status unknown partners (USUN) in the previous 4 months. We used generalized estimating equations, which account for repeated measures in each participant, to identify independent predictors of USUN.
 
RESULTS:
 
Of 189 subjects on HAART with confirmed drug resistance contributing 1037 visits, 77% were homosexual men, 9% were heterosexual men and 14% were heterosexual women;
 
29% reported USUN ≥1 visits and 6% reported USUN >75% visits.
 
In a multivariable model, methamphetamine use (OR 4.2, 95% CI 1.6-11.3, P=0.004) was a strong and independent risk factor for USUN.
 
There was also strong evidence for an effect of sildenafil (Viagra) use (OR 3.7, 95% CI 1.7-8.3, P=0.001), younger age (OR 3.2 per 10-year age decrease, 95% CI 1.8-5.7, P<0.001) and moderate evidence (P<0.10) for the effect of depression (OR 1.8, 95% CI 0.98-3.5) and homelessness (OR 4.7, 95% CI 0.88-24.7) in the past 4 months.
 
CONCLUSIONS: Among HIV-infected patients with drug-resistant virus, methamphetamine and sildenafil use are associated with high-risk sexual behaviour with HIV-uninfected partners. Because of the public health ramifications of the transmission of drug-resistant HIV, novel approaches are urgently needed to diminish the abuse of these recreational drugs.