Use of and Adherence to Antiretroviral Therapy Is Associated With Decreased Sexual Risk Behavior in HIV Clinic Patients

Data from two previous San Francisco studies have suggested that the availability of highly active antiretroviral therapy [ART] was associated with increased risky sexual behavior, noted the authors. However, these studies did not examine an ART-risky sex association cross-sectionally in the same patients.

In the current study, researchers assessed ART's relation to unprotected anal and vaginal sex (UAV) in a cross-sectional survey of 874 randomly selected, sexually active patients administered in 1998-1999 at six public HIV clinics in California. In a standardized interview, patients were asked about their HIV history, sexual behavior, illicit drug use, and ART therapy and adherence.

Of the patients, 34 percent reported UAV within the previous three months. Of the 79 percent receiving ART, only 26 percent said they were more than 95 percent adherent. ART was associated with decreased UAV regardless of age or gender in the stratified analysis. The odds ratio was less than 1 for all race/ethnicities. Decreased odds for UAV were found for ART use and adherence of 95 percent or greater, and while the relationships persisted in most stratified analysis, in multivariate analysis the relation held only for ART use. Undetectable viral RNA was associated with decreased odds of UAV.

"Contrary to expectations, use of and adherence to ART and their consequent suppression of HIV were associated with a decreased prevalence of self-reported risky sexual behavior," concluded the authors.

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