Youth with HIV take more risks after new meds introduced

Teens with HIV are having more risky sex with more partners than their counterparts did in the years before powerful new medications for HIV were introduced in 1996, according to a new report in the American Journal of Health Behavior.

A group of HIV-positive youth studied between 1999 and 2000 reported having more sexual partners, more unprotected sex and more drug use than HIV-positive youth studied between 1994 and 1996, say Marguerita Lightfoot, Ph.D. and colleagues at the UCLA AIDS Institute at the David Geffen School of Medicine.

Highly active antiretroviral therapies, or HAART, were introduced in 1996. The new drugs have successfully lowered virus levels and prolonged the lives of thousands of HIV patients.

Although the new study does not prove that the introduction of HAART is the cause of increased risky behavior, “these findings indicate the need for continued attention to the issue of sexual risk and the impact of HAART,” Lightfoot says.

The new study also suggests the lives of some HIV-positive teens have not improved with HAART. Lightfoot and colleagues found that the post-HAART group was in worse health, more likely to have been sexually abused and to be clinically distressed than the pre-HAART group.

“Targeted interventions for youth living with HIV that address risk behaviors and aim to improve quality of life are more needed now than ever before,” the researchers write.

Although HAART use has significantly improved the care of HIV patients, the longer lives of those patients could mean more opportunities to transmit the virus to others, says Lightfoot.

“Simultaneously, evidence suggests that many people living with HIV believe that sexual behaviors that could lead to the transmission of HIV, like unprotected sex, are less risky” if viral levels are low, she adds.

Although some studies suggest a shift toward risky behavior in adults in the post-HAART era, (see http://www.cfah.org/hbns/newsrelease/safe_sex11-01-01.cfm), Lightfoot and colleagues are among the first to examine whether HIV-positive youth are taking more risks as well.

To find out, they compared behaviors between 349 teens with HIV in Los Angeles, San Francisco, New York and Miami between 1994 and 1996 with 175 teens with HIV in the same cities between 1999 and 2000. Although the two groups did not include the same people, the groups were very similar in terms of sex, age, race and ethnicity and other socioeconomic characteristics.

The 1999-2000 post-HAART group was almost twice as likely as the pre-HAART group to have had unprotected sex in the last three months. On average, post-HAART youth had nearly double the sexual partners as pre-HAART youth. Post-HAART youth were also more likely to have had a sexual partner who used injection drugs.

The post-HAART group also knew their HIV diagnosis at a younger age and were in worse health than the pre-HAART group, the researchers found.

“Given the availability of HAART, it is surprising that the post-HAART youth experienced more symptoms. This suggests that although they are being identified as HIV-positive at a younger age, these youth are being identified later in the progression of the disease. Therefore, it is also likely that they were infected at a younger age,” Lightfoot says.

In the 1999-2000 group, only 53 percent of the teens were on HAART drug therapy.

Lightfoot says it’s “unclear” why more teens are not taking HAART. “It may be that physicians are reluctant to prescribe antiretroviral medications to certain subpopulations of youth, such as substance-using youth, because they fear the youth will not adhere to the treatment regimen.”

According to the Centers for Disease Control and Prevention, one-quarter of the 40,000 new HIV infections in the United States each year occur in people under age 21.

The Lightfoot study was supported by the National Institute on Drug Abuse.