Effect of Antiretroviral Therapy and Viral Load on the Perceived Risk of HIV Transmission and the Need for Safer Sexual Practices

Abstract

A small but significant proportion of HIV-infected people perceive the need for safer practices to be reduced during antiretroviral therapy, particularly those containing PIs. Even if the risk is truly reduced, the importance of safer practices should be conveyed consistently and terms such as "undetectable" to describe HIV RNA responses should be avoided.

Public Health Implications of Antiretroviral Therapy and HIV Drug Resistance

“…When patients were interviewed about perceptions of antiretroviral therapy, "undetectable" viral load, and risk behaviors, about 20% responded that protease inhibitors lowered HIV transmission risk and reduced the need for safer practices. 93 Other factors include the extent to which optimal antiviral drug concentrations can be attained in blood and genital compartments, whether either positive or negative drug interaction profiles in sexual fluids will mirror those observed in blood, and the toxicity profiles, pharmacokinetics, and bioavailability of individual antiviral agents in a given individual.…”

“…Very little study of adherence involving HIV therapy has been undertaken until recently, but the following principles emerge from studies on diabetes, coronary artery disease, tuberculosis, and aging [93][94][95][96][97] : (1) degree of adherence to therapy affects treatment outcome; low adherence reduces both efficacy and adverse effects 95,98,99 ; (2) adherence is poor across all populations and disease types (estimates of proportion of patients who fail to self-administer medications as prescribed range from 20% to 100% [average, 50%]) 94 ; (3) clinicians cannot predict who will or will not be adherent; and (4) care providers consistently overestimate the proportion of patients who will be adherent. Studies of zidovudine monotherapy suggest that these principles will be validated with HIV therapeutics.…”

Barebacking, the Internet, and Harm Reduction: An Intercept Survey with Gay and Bisexual Men in Los Angeles and New York City

“…Some have argued that the salience of HIV prevention messages has dramatically declined in recent years for a variety of reasons including the perception that, due to new treatments, many no longer consider HIV a ''death sentence'' (Dilley et al, 1997;Elford et al, 2001;Kippax and Race, 2003;Kravcik et al, 1998;Miller et al, 2000;Murphy et al, 1999;Pinkerton and Holtgrave, 1999;Remien et al, 1998;Van de Ven et al, 1999;Vanable et al, 2000). Others have argued gay communities are experiencing ''condom fatigue,'' or the idea that gay and bisexual men are tired of hearing about HIV prevention or being told how to have sex (Geidin, 1997;Rofes, 1999a;Salyer, 1999;Scarce, 1998).…”

Unsafe Sexual Behavior Among HIV-Infected Patients in Croatia, 2006: Prevalence and Associated Factors

“…Not only are such infections markers of unsafe sexual activity, but they also contribute to an increased potential for HIV transmission due to the synergistic effect of ulcerative STIs on HIV infectivity (Cohen 1998;Fleming and Wasserheit 1999). Furthermore, studies suggest that patients' optimism about the effectiveness of ART may contribute to relaxed attitudes toward risky sex practices (Dilley et al 1997;Dilley et al 2003;Kelly et al 1998;Kravcik et al 1998; Van de Ven et al 2000; Van de Ven et al 2002). In addition, it is noteworthy that HIV-infected patients who receive ART and who engage in HIV transmission risk behaviors may harbor and spread drug-resistant HIV, which adds considerably to the public health threat (Kozal et al 2004).…”