Recent reports have documented increases in unprotected intercourse (UI) and sexually transmitted diseases (STDs) among men who have sex with men (MSM) and other at-risk populations. A further consequence of persons living with HIV engaging in unprotected intercourse or shared parenteral exposures with seroconcordant partners is HIV recombination and superinfection, possibly with a drug-resistant or more pathogenic virus. The epidemiologic, clinical, and therapeutic implications of recent case reports confirming superinfection in persons living with HIV, as well as research priorities aimed at providing a more thorough understanding of the consequences of unprotected sex among HIV-infected people, are explored here.
*Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; and the †Research and Evaluation Department, Fenway Community Health, Boston, Massachusetts, and Miriam Hospital/Brown University, Providence, Rhode Island
The authors thank the dedicated staff of Fenway Community Health, as well as countless volunteers who have made their work over the years possible.
Correspondence: Kenneth Mayer, MD, Research and Evaluation Department, Fenway Community Health, 7 Haviland Street, Boston, MA 02115. E-mail: Kenneth_Mayer@brown.edu
Received for publication October 30, 2003, and accepted November 7, 2003.