HIV Meds Don't Up Intravenous Drug Abusers' Risk-Taking

Intravenous drug users with HIV do not increase sexual risk-taking after initiating antiretroviral therapy, according to a new Canadian study. Some short-term studies have suggested otherwise, raising concerns that ART might be associated with IDUs having more unprotected sex and more sex partners.

The new study used data from a long-term cohort of HIV-positive IDUs in British Columbia, with data on ART initiation determined by linkage to a centralized ART dispensary. The study used generalized linear mixed-effects modeling to examine sexual activity, unprotected intercourse, and multiple partnerships in the 12 months following initiation of ART.

Of 457 ART-naive individuals (median age 34), 202 (44.2 percent) were women. Between May 1996 and April 2008, 260 (56.7 percent) initiated ART. During follow-up interviews, 17 percent of participants reported unprotected sex, and 27 percent reported multiple partners. However, participants were no more likely to take sexual risks after ART initiation than before.

"In multivariate analyses, ART initiation was not associated with sexual activity [adjusted odds ratio (AOR)=0.87, 95 percent confidence interval (CI) 0.60-1.25], unprotected intercourse (AOR=0.82, 95 percent CI 0.51-1.31), or multiple sexual partnerships (AOR=0.93, 95 percent CI 0.61-1.40)," the study found.

"In light of this evidence, and given the known positive effect of ART on survival and its potential role in reducing HIV transmission, concerns regarding potential increases in sexual risk-taking should not undermine the delivery of ART to IDUs," concluded Brandon Marshall, PhD candidate at the University of British Columbia, and colleagues.

The full report, "No Evidence of Increased Sexual Risk Behavior After Initiating Antiretroviral Therapy Among People Who Inject Drugs," was published ahead of the print edition of AIDS (2010;doi:1097/QAD.0b013e32833dd101).

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