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Good relationship but fear of infection
Aug 18, 1999

Dear Dr. Reiman:

I am currently enjoying a good relationship with a wonderful woman, I am HIV+ and she is negative. We use a condom when we have intercourse but do not for oral sex. We also do alot of unprotected genital rubbing and once the condom has broken. She is very concerned about getting infected and this has become a major problem in our relationship. After a baseline viral load of 1800, I have been <50 copies for the past 2.5 years. Would you know to what extent having low viral load like this affects the chance of transmission?

Response from Dr. Remien

As far as I know there is no definitive answer to your specific question. There is biological evidence that shows that lower viral load is associated with reduced risk of transmission. The converse is that there is a higher degree of infectiousness when viral load is high. However there is also evidence that shows there is not always a one-to-one correspondence between plasma (blood) viral load and the viral load of genital secretions (e.g., semen). In other words, viral load of plasma (the test results that you receive) can be very low, but viral load of semen can be higher. Therefore experts are not comfortable telling people that they are less infectious when their plasma viral load is low, because this may not be true.

You and your partner should ask any questions you have of your health care providers. You also need to find ways of having satisfying sex that is not filled with anxiety for either, or both of you. There are a lot of counselors that can help you with this. I think it is important for you and your partner to address the issues and confront the concerns, rather than ignoring them. Since there are no guarrantees, figure out what is going to work for the two of you that will enable you to have satisfying sex that also allows you both to feel "safe."

Take care and be well.


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