 |
|
|
| |
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.
| |
| |
| |
| |
|
|
|
|
|
