Question | Discussion | References | CME Credit

Updated January 29, 2009

Case 1: High-Risk Behavior Among HIV-infected Individuals

Authors: Emily Darby, MD David H. Spach, MD

A 28-year-old HIV-infected man who is new to the area presents to an HIV clinic to establish primary care. He thinks he acquired HIV 3 years ago from a sexual partner who used intravenous drugs. He recently initiated combination antiretroviral therapy after his CD4 count declined to 300 cells/mm3. He has a new relationship that he describes as "serious"; his new boyfriend is HIV-negative, and they use condoms for anal but not oral sex. He also has insertive anal intercourse 2 to 3 times per month with men he meets at a local bathhouse, and he rarely uses condoms with these men because he assumes they are HIV-infected. He frequently uses sildenafil (Viagra) at the bathhouse to enhance his sexual performance. He injects methamphetamine 4 to 6 times per month, but he uses clean syringes obtained through a needle exchange program. He says he very rarely shares syringes.

Which of the answers below is TRUE regarding high-risk behavior among HIV-infected individuals?

A It is unusual that this individual has remained sexually active despite having HIV infection, since fewer than 20% of HIV-infected men remain sexually active once they have a diagnosis of HIV.
B Although many HIV-infected men, such as this patient, are sexually active, fewer than 5% of them engage in unprotected anal intercourse.
C His practice of having casual sex only with partners whom he assumes are HIV-infected reduces his likelihood of acquiring a sexually transmitted disease (STD).
D Medications used to treat erectile dysfunction have been associated with increased unsafe sexual practices in HIV-infected men who have sex with men (MSM).