HAART and Sexual Risk BehaviorHAART and Sexual Risk Behavior

To the Editor: Dr Crepaz and colleagues conclude that human immunodeficiency virus (HIV)–infected patients taking highly active antiretroviral therapy (HAART) did not exhibit increased sexual risk behavior, even when therapy achieved an undetectable viral load.¹ In their discussion, the authors state that medical factors, such as duration of HAART or disease stage, might elucidate their findings because patients initiating HAART may have symptomatic illness that decreases their interest in sex.

In a recent study, my colleagues and I examined the relationship between unprotected sex (defined as anal or vaginal sex without a condom within the past 3 months) and antiretroviral use in a cross-sectional survey conducted in 874 randomly selected, sexually active patients at 6 public HIV clinics in California in 1998-1999.² We found a decreased odds ratio (OR) for unprotected sex with both antiretroviral use (OR, 0.5; 95% confidence interval [CI], 0.4-0.7) and self-reported undetectable HIV RNA level (OR, 0.6; 95% CI, 0.5-0.8). Among 689 antiretroviral-treated patients, unprotected sex occurred in 32% of patients with CD4 cell counts lower than 200 cells/μL, in 31% of patients with CD4 cell counts between 200 and 499 cells/μL, and in 31% of patients with CD4 cell counts higher than or equal to 500 cells/μL(χ²₂=0.09; P=.96). The duration of HIV infection did not differ significantly between those patients who engaged in unprotected sex vs those who did not (mean 6.6 years vs 6.2 years, respectively, t test, P=.16). The CD4 cell count and duration of HIV infection was not associated with sexual risk behavior among antiretroviral-treated HIV clinic patients.