Suchergebnisse

Tuberculosis (TB) and human immunodeficiency virus (HIV) disease have been closely entwined since the early years of the HIV/AIDS pandemic. The 2 conditions overlap in their epidemiologic characteristics and clinical manifestations and are both clothed in stigma. They individually carry the risk of creating social, economic, and political instability, which is markedly worsened when they affect a region in concert. The overwhelming burden of disease due to both TB and HIV is borne by resource-limited countries and the hardest hit among these are in sub-Saharan Africa. In sub-Saharan Africa, the HIV epidemic is accelerating what was already a massive TB epidemic, with the incidence rate of TB increasing from 146 per 100,000 in 1990 to 345 per 100,000 in 2003. Each disease contributes to the morbidity and mortality of the other. TB is now the leading cause of death among persons with HIV disease. HIV increases the risk of reactivation of latent TB infection (LTBI) and progression to active TB disease more than any other known risk factor. In some countries, the percentage of patients with active TB who are coinfected with HIV is now greater than 60%. Even with appropriate management of TB, patients with HIV co-infection have increased mortality as a consequence of HIV-related complications.

BackgroundPopulation‐based and longitudinal information regarding sexual risk behavior among patients with multidrug resistant (MDR) HIV and their sexual partners is of great public health and clinical importance.ObjectiveTo characterize the HIV sexual risk behaviors of patients with and without drug‐resistant HIV in the clinical care setting over time.Measurements393 HIV‐positive patients completed questionnaires of self‐reported sexual risk behaviors at approximate 6‐month intervals extending over 24 months. HIV viral load and genotypic drug resistance obtained during the same time points were matched to the behavioral data. Multidrug resistance was defined as having resistance to 2 or 3 antiretroviral (ARV) drug classes.ResultsIn serial cross‐sectional analyses, 393 patients (44% female and 79% heterosexual) contributed 919 matched behavioral and virologic results over the 24 months of data collection. Of these, 250 patients (64%) reported having sex during at least 1 survey period resulting in greater than 10,000 sexual events with more than 1000 partners. Unprotected sexual behavior was reported by 45% of sexually active patients, resulting in 34% of all sex events that exposed 29% of all partners. Of these patients with unprotected sexual events, 31% had HIV drug resistance 11.6% with resistance to 2 classes of ARVs (2‐class), and 1.8% with 3‐class ARV resistance at the time of a sexual risk event. Close to 1000 or 28% of all unprotected sexual events involved resistant strains (11% of these with resistance to 2 classes and 0.2% with 3‐class resistance, exposing 20% of unprotected sexual partners to resistant HIV (8% to 2‐class and 0.6% to 3‐class resistance).In longitudinal analysis among the 78 patients who reported a cumulative total of 12 months of sexual history and had resistance testing, 38% reported engaging in unprotected sexual behavior. There was substantial and complex variation in the distribution of unprotected sexual events and in the detection of resistance over time.ConclusionIn this study of HIV sexual risk and resistance over time among HIV‐infected patients in clinical care, a substantial proportion engaged in unprotected sex and had drug‐resistant HIV, frequently exposing partners to 1‐ or 2‐class resistant HIV strains. However, relatively few exposures involved 3‐class resistance. The dynamics of sexual risk behavior and HIV drug resistance are complex and vary over time and urgently require both general and targeted interventions to reduce transmission of resistant HIV.