Changes in transmission risk behaviors across stages of HIV disease among people living with HIV.

Advances in treatments for HIV infection and related opportunistic illnesses have significantly extended the life expectancy of people living with HIV. A review of the literature on HIV transmission risks among HIV-infected individuals shows patterns of risk behavior that vary according to HIV disease stage. Studies confirm that the period immediately preceding HIV infection is characterized by high rates of risk behaviors, indicating the potential for rapid spread of HIV during acute infection. Reductions in risk behavior are often seen immediately following an HIV diagnosis. However, these behavioral changes are not universal, and an individual's state of health is an important factor relating to transmission risks. Chronic periods of asymptomatic HIV infection are generally associated with some degree of reverting to risky behaviors. CD4 cell counts below 200 cells/mm(3), resulting in a formal diagnosis of AIDS, are associated with decreased sexual and drug-related risk behaviors. HIV risk reduction interventions for HIV-infected persons, therefore, require tailoring to address the health and psychological challenges individuals face as they progress through stages of HIV disease. Additional research on both risk behaviors of long-term HIV-infected persons and longitudinal data on risk behaviors is needed.