Increase in At-Risk Sexual Behavior among HIV-1-Infected Patients Followed in the French PRIMO Cohort

The incidence of STDs among homosexuals and heterosexuals has recently increased in France and other industrialized countries. This rise coincides with widespread use of HAART, and probably reflects a greater prevalence of unprotected sex. The current study assessed the characteristics and plasma viral load of 233 HIV-1-infected patients who reported sexual behavior at risk for HIV transmission (SBR) in a study conducted between November 1996 and February 2002.

Seventy-nine percent of the study subjects were men, of whom sixty-one percent said they were homosexual or bisexual. All forty-seven women identified themselves as heterosexual. Median age of participants at enrollment was 31. Fifty percent of the patients had an asymptomatic or briefly symptomatic primary infection.

Overall, 87 percent of the patients reported having at least one sexual partner during the three-month follow-up period, and 32 percent reported having unprotected sex at least once. Patients reporting SBR did not differ from other patients in terms of plasma viral load, suggesting that the patient's knowledge of his or her response to HAART was not a major determinant of subsequent at-risk sexual behavior.

The authors observed an increase in unprotected sex with casual partners (from 5.1 percent in 1998 to 21.1 percent in 2001-02) among subjects enrolled in the PRIMO cohort shortly after primary HIV-1 infection. Patients reporting SBR did not differ from other patients in plasma viral load. The study found an independent positive association between previously developed lipodystrophy and signs of anxiety/depression in patients who reported SBR.

Although the study's follow up may have been too short to allow patients to adapt their sexual behavior to their response to treatment, the findings reinforce the notion that HAART, or the response to it, is not the sole determinant of at-risk sexual behavior.

Higher incidence of unsafe sex among HIV-infected individuals, the researchers conclude, raises concern about the potential for re-emerging HIV epidemics.

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