Drug-resistant HIV often spread among drug users

The transmission of drug-resistant HIV among intravenous drug users (IDUs) who participate in high-risk behaviors is high, according to a new study. In addition, such drug users were often prescribed less effective and not recommended HIV drugs.

Evidence of increasing rates of drug resistance among those recently infected with HIV “indicates a growing public health concern and warrants an examination of the problems from a prevention perspective write the Journal of Acquired Immune Deficiency Syndromes.

The researchers examined predictors of unprotected sex and needle sharing among 638 HIV-infected drug users who completed 2731 visits between 1996 and 2000 in an ongoing study in Baltimore, Maryland.

“After taking account other factors, HIV-infected individuals were significantly more likely to engage in unprotected sex if their sexual partners were also HIV-infected,” Dr. Sethi said in an interview with Reuters Health. “Also, HIV-infected women were twice as likely as men to report unprotected sex.”

Among IDUs who had injected recently, there was an independent association between sharing needles and homelessness, daily injection, and trading sex for drugs. “IDUs were at higher risk of HIV and drug-resistant HIV transmission at 19 percent and 6 percent of all visits, respectively,” the investigators write. Among subjects who were at high risk of HIV transmission, significant drug-resistant HIV was found at 14 percent of visits.

“Although highly active antiretroviral therapy (HAART) was widely available during the study period, less effective and not recommended regimens were prescribed to nearly half of IDUs who were potential transmitters of drug-resistant HIV,” Dr. Sethi told Reuters Health. “Transmission of resistance is one consequence of continued wide-use of non-HAART regimens.”

“It is likely that reducing high-risk behaviors by HIV-infected individuals would reduce the transmission of HIV, including drug-resistant HIV, to uninfected individuals,” Dr. Sethi said. “Clinicians can play an important role by counseling HIV-infected patients about the importance of reducing high-risk behaviors.”

SOURCE: Authors: Dr. Ajay K. Sethi, of Case Western Reserve University School of Medicine,Cleveland, Ohio, and colleagues. Published in Journal of Acquired Immune Deficiency Syndromes, April 15, 2004.

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