Sexual and drug risk-related behaviours after initiating highly active antiretroviral therapy among injection drug users

Objective: To assess whether initiation of highly active antiretroviral therapy (HAART) is associated with a subsequent resumption of sexual and drug use risk behaviors. Methods: Within an ongoing prospective study of HIV-seropositive injection drug users (IDUs), a subsample with at least one CD4 cell count < 500 × 10⁶ cells/l after 1996 (when HAART became available) and three consecutive visits were selected for analysis. Patients underwent semi-annual interviews for risk behaviors and reports of medication use. Data from visits immediately prior to and following initiation of HAART for the treated group, and from consecutive visits for the eligible but untreated group were compared using linear growth curve analysis. Results: Of 316 eligible HIV-seropositive IDUs, 133 reported HAART use during the study period; 95% were African American, 76% were male, and median age at enrollment was 34 years. The proportion who reported any sexual activity increased over time from 55 to 61% for the HAART-treated group, but decreased from 67 to 63% in the untreated group (P = 0.03); the respective values for unprotected sex were 18 versus 20% and 36 versus 28% (P = 0.06). In both treated and untreated groups, the proportion injecting drugs declined (P = 0.04), whereas the proportion reporting needle sharing decreased marginally (P = 0.11). However, trends in use of shooting galleries between the groups differed (P = 0.04) increasing slightly from 2.3 to 3% in the treated group while decreasing from 12 to 5% in the untreated group. Conclusion: In persons treated with HAART, self-report of high-risk behaviors remained stable or showed some increase. Persons initiating HAART should be counselled to refrain from high-risk behaviors.