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.
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.
Authors: Tracey E Wilson; Yolanda Barrón; Mardge Cohen; Jean Richardson; Ruth Greenblatt; Henry S Sacks; Mary Young Journal: Clin Infect Dis Date: 2002-01-09 Impact factor: 9.079
Authors: Andrew J Leigh Brown; Simon D W Frost; W Christopher Mathews; Keith Dawson; Nicholas S Hellmann; Eric S Daar; Douglas D Richman; Susan J Little Journal: J Infect Dis Date: 2003-01-29 Impact factor: 5.226
Authors: Susan J Little; Sarah Holte; Jean-Pierre Routy; Eric S Daar; Marty Markowitz; Ann C Collier; Richard A Koup; John W Mellors; Elizabeth Connick; Brian Conway; Michael Kilby; Lei Wang; Jeannette M Whitcomb; Nicholas S Hellmann; Douglas D Richman Journal: N Engl J Med Date: 2002-08-08 Impact factor: 91.245
Authors: Rachel C Flaks; William J Burman; Patrick J Gourley; Cornelis A Rietmeijer; David L Cohn Journal: Sex Transm Dis Date: 2003-05 Impact factor: 2.830
Authors: Robert M Grant; Frederick M Hecht; Maria Warmerdam; Lea Liu; Teri Liegler; Christos J Petropoulos; Nicholas S Hellmann; Margaret Chesney; Michael P Busch; James O Kahn Journal: JAMA Date: 2002-07-10 Impact factor: 56.272
Authors: Ajay K Sethi; David D Celentano; Stephen J Gange; Joel E Gallant; David Vlahov; Homayoon Farzadegan Journal: J Acquir Immune Defic Syndr Date: 2004-04-15 Impact factor: 3.731
Authors: Hannan M Braun; Jury Candelario; Courtney L Hanlon; Eddy R Segura; Jesse L Clark; Judith S Currier; Jordan E Lake Journal: LGBT Health Date: 2017-09-06 Impact factor: 4.151
Authors: Angela A Aidala; Michael G Wilson; Virginia Shubert; David Gogolishvili; Jason Globerman; Sergio Rueda; Anne K Bozack; Maria Caban; Sean B Rourke Journal: Am J Public Health Date: 2015-11-12 Impact factor: 9.308