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Study links nonadherence to HIV treatment regimens and women's risky sexual behavior

Individuals infected with the human immunodeficiency virus (HIV) that causes AIDS can slow disease progression and minimize HIV transmission to sexual partners if they adhere to complex HIV medication regimens. Lapses in medication adherence can quickly lead to disease progression which, in turn, can lead to transmission of drug-resistant strains of HIV to sexual partners.

Two-thirds (66 percent) of a national sample of HIV-infected women adhered very well to HIV treatment regimens (took all medications as prescribed 95 percent or more of the time). Unfortunately, those whose adherence was less than ideal (all medications taken less than 95 percent of the time) were more than twice as likely to engage in unprotected sexual activity compared with women whose adherence to treatment regimens was high, according to researchers participating in the national Women's Interagency HIV Study (WIHS).

Women who were less adherent were more likely than those who adhered to treatment to have a detectable virus load, more impaired immune systems (CD4 count less than 200 cells/mm3), and bothersome symptoms; use condoms inconsistently (47 vs. 29 percent); and report drug use (16 vs. 8 percent). It may be that a woman who is willing to take risks with regard to sexual activity also may be more likely to take the risk of virologic failure by not adhering to a treatment regimen. On the other hand, these women may not have lifestyles that support healthy behaviors in general, suggest the researchers. They recommend that doctors discuss with HIV-positive women the increased risks associated with treatment nonadherence and unprotected sexual activity and the link between the two.

In the WIHS, which is jointly supported by the Agency for Healthcare Research and Quality, the National Institutes of Health, and the Centers for Disease Control and Prevention, data were collected on 766 HIV-positive women in the United States from October 1998 to March 1999 on adherence to therapy, risk behavior, and disease markers.

See "Adherence to antiretroviral therapy and its association with sexual behavior in a national sample of women with human immunodeficiency virus," by Tracey E. Wilson, Ph.D., Yolanda Barron, Ph.D., Mardge Cohen, M.D., and others, in the February 15, 2002 Clinical Infectious Diseases 34, pp. 529-534.

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