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November 17, 2004

HAART and Sexual Risk Behavior—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(19):2335-2336. doi:10.1001/jama.292.19.2336-a

In Reply: Dr Diamond and colleagues provide analyses that examine whether CD4 cell counts and the duration of HIV infection are associated with unprotected sex in a heterogeneous sample of HIV-positive patients. As discussed in our meta-analytic review, analyses like these are informative for obtaining a better understanding of how medical factors may affect the relationship between receipt of HAART and sexual risk behavior among persons infected with HIV. Although Diamond and colleagues did not find any association between CD4 cell counts, an indicator of disease stage, and sexual risk behavior in their cross-sectional study, a recent longitudinal study1 conducted survival analyses of 190 HIV-infected injection drug users who initiated HAART during 1996-2000 and found that an increase in CD4 cell count after HAART initiation was significantly associated with engaging in unprotected sexual intercourse, a finding that is consistent with our discussion. However, given that potentially conflicting conclusions may be reached when different subsets of studies are considered, it is still important to integrate all findings meta-analytically. We encourage researchers to provide information on analyses of medical factors to assist future synthesis efforts.

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