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Opportunities for sexual transmission of antiretroviral drug resistance among HIV-infected patients in care

Soeters, Heidi M.a; Napravnik, Soniaa,b,c; Zakharova, Oksana M.b,c; Eron, Joseph J.b,c; Hurt, Christopher B.b

doi: 10.1097/01.aids.0000433240.78739.30
Clinical Science

Objective: To assess opportunities for transmitted drug resistance (TDR), we examined sexual risk behaviours, HIV viraemia and antiretroviral resistance among patients in care.

Design: A retrospective, cross-sectional analysis of clinical cohort data.

Methods: For 244 UNC Center for AIDS Research HIV Clinical Cohort participants, demographic and behavioural data were obtained during in-person interviews between 2000 and 2011. Genotypic resistance tests were interpreted using WHO surveillance drug resistance mutations (SDRMs). Log-linear binomial regression was used to evaluate associations with TDR risk, defined as unprotected sex in the prior 6 months, HIV RNA at least 400 copies/ml and at least one SDRM.

Results: Participants included 91 (37%) women and 153 men, of whom 92 (60%) were MSM. Median age was 43 years; 70% were Black (n = 171). Most (97%) were antiretroviral-experienced; 44% had exposure to more than four regimens. Among 204 individuals on antiretrovirals, 42% reported suboptimal adherence and 29% were viraemic. Over half of participants had at least one SDRM (n = 131); 26 (11%) had triple-class resistance. Overall, 70% were sexually active, and 55% used condoms inconsistently. Thirty (12%) reported unprotected sex during periods of drug-resistant viraemia. Higher TDR risk was associated with prior homelessness [adjusted prevalence ratio (aPR) 2.20, 95% confidence interval (CI) 1.16–4.18], active substance use (aPR 3.12, 95% CI 1.47–6.62) and nonsignificantly with MSM (aPR 1.75, 95% CI 0.93–3.28).

Conclusion: A small but significant proportion of clinic patients with drug-resistant HIV engage in sexual behaviours that place others at risk for TDR. Targeted efforts in secondary prevention could have an impact on TDR incidence, over time.

aDepartment of Epidemiology

bInstitute for Global Health and Infectious Diseases

cCenter for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Correspondence to Christopher B. Hurt, Institute for Global Health and Infectious Diseases, 130 Mason Farm Road, CB #7030, Chapel Hill, NC 27599-7030, USA. Tel: +1 919 966 2789; fax: +1 919 966 6714; e-mail:

Received 24 May, 2013

Revised 14 June, 2013

Accepted 8 July, 2013

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© 2013 Lippincott Williams & Wilkins, Inc.