HIV transmission risk behavior and its relation to antiretroviral treatment adherence

Background. Rising rates of antiretroviral drug resistance among recently infected persons are evidence of high-risk behavior among persons in HIV care. Goal: The goal was to determine HIV transmission risk behavior among persons in HIV care and evaluate its association with treatment adherence. Study Design: The study involved a structured interview of a random sample of patients in HIV care in an urban public clinic. Participants were categorized by transmission risk: high risk = unprotected anal/vaginal sex and/or needle sharing; low risk = protected anal/vaginal sex, unprotected and/or protected oral sex, no needle sharing; no risk = no sex or needle sharing. Results: Of the 95 participants, 21 (22%) reported high-risk behavior, 36 (38%) reported low-risk behavior, and 38 (40%) reported no transmission risk in the past 3 months. Younger, more educated persons and those with an active substance abuse diagnosis were more likely to have high transmission risk (P less than or equal to 0.05). Patients who engaged in high-risk behavior had equivalent use of antiretroviral therapy (P = 0.80) but lower adherence (P less than or equal to 0.01) and higher median plasma viral loads (P = 0.05). Conclusions: There was a wide spectrum of transmission risk behavior among persons in HIV care. Persons reporting high-risk behavior were less adherent to antiretroviral therapy, providing a behavioral basis for transmission of drug-resistant HIV.