Antiretroviral resistance and high-risk transmission behavior among HIV-positive patients in clinical care

AIDS. 2004 Nov 5;18(16):2185-9. doi: 10.1097/00002030-200411050-00011.


Background: HIV-positive patients receiving antiretroviral therapy (ART) who engage in HIV transmission behaviors may harbor and transmit drug-resistant HIV. However, little is known about the risk behaviors of these patients, potential partners exposed and the relationship of these to ART resistance.

Objective: To determine the relationship of HIV drug resistance and continuing HIV transmission risk behavior among HIV-positive patients in care.

Methods: A retrospective, cross-sectional study of HIV transmission risk behavior and HIV drug resistance data from 333 HIV-positive patients.

Results: Among a diverse population of 333 HIV-positive patients, 75 (23%) had unprotected sex during the previous 3-months, resulting in 1126 unprotected sexual events with 191 partners of whom 155 were believed by patients to be HIV-negative or of unknown status. Eighteen of the 75 (24%) had resistant HIV and 207 unprotected sexual events, exposing 18% of the HIV- or status unknown partners. There was no difference in the proportion of patients engaging in unprotected sex who had undetectable viral load (VL) (22%): VL > 400 copies/ml without resistance (20%) and VL > 400 copies/ml with resistance (26%). Resistance and risk behavior was predicted only by lower mental health scores (odds ratio, 10.3; 95% confidence interval, 1.7-18.6).

Conclusion: A substantial minority (23%) of patients in clinical care engaged in HIV sexual transmission risk behavior. A small subset of these also had ART-resistant HIV. However, this core group (approximately 5% of all patients) accounted for a large number of high-risk HIV transmission events with resistant virus, exposing a substantial number of partners.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Anti-HIV Agents*
  • Antiretroviral Therapy, Highly Active
  • Bisexuality
  • Cross-Sectional Studies
  • Drug Resistance, Multiple, Viral*
  • Educational Status
  • Female
  • HIV Infections / drug therapy
  • HIV Infections / psychology
  • HIV Infections / transmission*
  • Humans
  • Male
  • Mental Health
  • Odds Ratio
  • Prevalence
  • Retrospective Studies
  • Risk
  • Unsafe Sex


  • Anti-HIV Agents