ART Drug Resistance and Risk Behavior Among Recently HIV-infectected
ART Drug Resistance and Risk Behavior Among Recently HIV-infectected
Objectives: Examine associations among behaviors including substance use during sexual encounters, and transmitted HIV drug resistance in recently HIV-infected men who have sex with men (MSM).
Methods: Between 2002 and 2006, 117 recently HIV-infected MSM completed questionnaires regarding their 3 most recent sexual partners. Serum samples were tested for the presence of genotypic and phenotypic HIV drug resistance. Logistic regression analysis was used to assess the association of substance use, behaviors, and resistance to at least 1 class of HIV drugs.
Results: The mean age of participants was 35 years; 71% identified as white and 19% as Hispanic. Sixty (51%) reported substance use during sexual activity in the past 12 months. A total of 12.5% of 112 had genotypic drug resistance to at least 1 class of antiretroviral medications, and 14% of 117 had phenotypic drug resistance. Substances used during sexual activity associated with phenotypic drug resistance in multivariate models included any substance use (adjusted odds ratio [aOR] = 4.21, 95% confidence interval [CI]: 1.13 to 15.68), polysubstance use (aOR = 5.64, 95% CI: 1.62 to 19.60), methamphetamine (aOR = 4.00, 95% CI: 1.19 to 13.38), 3,4-methylenedioxy-N-methylamphetamine (MDMA)/Ecstasy (aOR = 7.16, 95% CI: 1.40 to 36.59), and γ-hydroxyl butyrate (GHB) (aOR = 6.98, 95% CI: 1.82 to 26.80). The genotype analysis was similar.
Conclusions: Among these recently HIV-infected MSM, methamphetamine use during sexual activity and use of other substances, such as MDMA and GHB, was associated with acquired drug-resistant virus. No other behaviors associated with acquisition of drug-resistant HIV.
The increasing prevalence of drug-resistant strains of HIV has caused concern about the transmission of resistant strains of HIV and the future effectiveness of antiretroviral therapy (ART). Prevalence of primary or transmitted drug resistance has been measured as high as 26% in North America and Western Europe, with evidence from mathematic modeling studies showing the potential for substantial transmission of drug resistance. Although the prevalence of primary drug resistance is well documented, less is known about mechanisms and risk factors for transmission. Significant public health interest was given to a case of transmitted multiple drug-resistant HIV found in a man with primary HIV infection who reported methamphetamine use, leading to speculation about the role of substance use in the acquisition of resistant HIV. Additionally, there is empiric evidence associating use of illicit substances, such as methamphetamine, amyl nitrites (poppers), cocaine, and Ecstasy, with high-risk sexual behavior and with incident sexually transmitted infections, including HIV, among men who have sex with men (MSM). Higher rates of substance use and HIV among MSM, compared with the general population, highlight the importance of understanding the potential role of substance use in the transmission of drug-resistant HIV in this population. Although frequent methamphetamine use reported by MSM has been associated with transmitted resistance, the significance of its use during sexual activity remains unclear. Possible mechanisms that may facilitate transmission of resistant virus include reductions in immune function because of substance use, repeated exposure by the same partner, concentration of resistant HIV in certain sexual networks, or specific sexual practices during substance use. This study examines the associations between reported use of substances, including methamphetamine, amyl nitrites, cocaine, γ-hydroxyl-butyrate (GHB), 3,4-methylenedioxy-N-methylamphetamine (MDMA), and marijuana, during sexual encounters, other risk behaviors, and the presence of transmitted HIV drug-resistant strains among a cohort of treatment-naive recently HIV-infected MSM.
Objectives: Examine associations among behaviors including substance use during sexual encounters, and transmitted HIV drug resistance in recently HIV-infected men who have sex with men (MSM).
Methods: Between 2002 and 2006, 117 recently HIV-infected MSM completed questionnaires regarding their 3 most recent sexual partners. Serum samples were tested for the presence of genotypic and phenotypic HIV drug resistance. Logistic regression analysis was used to assess the association of substance use, behaviors, and resistance to at least 1 class of HIV drugs.
Results: The mean age of participants was 35 years; 71% identified as white and 19% as Hispanic. Sixty (51%) reported substance use during sexual activity in the past 12 months. A total of 12.5% of 112 had genotypic drug resistance to at least 1 class of antiretroviral medications, and 14% of 117 had phenotypic drug resistance. Substances used during sexual activity associated with phenotypic drug resistance in multivariate models included any substance use (adjusted odds ratio [aOR] = 4.21, 95% confidence interval [CI]: 1.13 to 15.68), polysubstance use (aOR = 5.64, 95% CI: 1.62 to 19.60), methamphetamine (aOR = 4.00, 95% CI: 1.19 to 13.38), 3,4-methylenedioxy-N-methylamphetamine (MDMA)/Ecstasy (aOR = 7.16, 95% CI: 1.40 to 36.59), and γ-hydroxyl butyrate (GHB) (aOR = 6.98, 95% CI: 1.82 to 26.80). The genotype analysis was similar.
Conclusions: Among these recently HIV-infected MSM, methamphetamine use during sexual activity and use of other substances, such as MDMA and GHB, was associated with acquired drug-resistant virus. No other behaviors associated with acquisition of drug-resistant HIV.
The increasing prevalence of drug-resistant strains of HIV has caused concern about the transmission of resistant strains of HIV and the future effectiveness of antiretroviral therapy (ART). Prevalence of primary or transmitted drug resistance has been measured as high as 26% in North America and Western Europe, with evidence from mathematic modeling studies showing the potential for substantial transmission of drug resistance. Although the prevalence of primary drug resistance is well documented, less is known about mechanisms and risk factors for transmission. Significant public health interest was given to a case of transmitted multiple drug-resistant HIV found in a man with primary HIV infection who reported methamphetamine use, leading to speculation about the role of substance use in the acquisition of resistant HIV. Additionally, there is empiric evidence associating use of illicit substances, such as methamphetamine, amyl nitrites (poppers), cocaine, and Ecstasy, with high-risk sexual behavior and with incident sexually transmitted infections, including HIV, among men who have sex with men (MSM). Higher rates of substance use and HIV among MSM, compared with the general population, highlight the importance of understanding the potential role of substance use in the transmission of drug-resistant HIV in this population. Although frequent methamphetamine use reported by MSM has been associated with transmitted resistance, the significance of its use during sexual activity remains unclear. Possible mechanisms that may facilitate transmission of resistant virus include reductions in immune function because of substance use, repeated exposure by the same partner, concentration of resistant HIV in certain sexual networks, or specific sexual practices during substance use. This study examines the associations between reported use of substances, including methamphetamine, amyl nitrites, cocaine, γ-hydroxyl-butyrate (GHB), 3,4-methylenedioxy-N-methylamphetamine (MDMA), and marijuana, during sexual encounters, other risk behaviors, and the presence of transmitted HIV drug-resistant strains among a cohort of treatment-naive recently HIV-infected MSM.