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sero sorting, unprotected sex, and treatments
Jan 26, 2006

Hi,

Can you give me your opinion about having unprotected sex with other hiv positive men. I am positive and am on HAART and have an undetectable viral load. Can I destabilise my regimen? How likely is it to happen? Is there anything else i should know about making this choice?

Thanks.

Response from Dr. Frascino

Hello,

This topic is a conundrum!

First, the "good" news. Preliminary research suggests that superinfection (an HIV-positive person acquiring a second, more aggressive, strain of the virus) is a relatively rare event for folks chronically infected. That doesn't mean it can't or doesn't happen. There are indeed documented cases; however, these have been noted to occur primarily in those recently infected (within one-two years) and/or in those not taking medication (or taking their medications improperly).

Serosorting (limiting sex to those partners who have the same HIV status) may be one of the prime contributing factors to the significant decline in the incidence of new HIV infections in gay men in San Francisco.

So that's the "good" news. What about the "bad" news? Unprotected sex, serosorted or not, leaves you open to other STDs that are much easier to contract than HIV for instance, syphilis, chlamydia, gonorrhea, hepatitis B and C, HPV and herpes. STDs can cause HIV viral load increase (increased viral replication). This in turn can "destabilize your regimen."

The bottom line is that "serosorting" may help decrease the overall incidence of new HIV infections; however, unprotected sex is indeed a significant risk to all involved and particularly to those of us who are trying to coexist with a virus that wants to destroy us. Finding an effective HAART regimen that you can tolerate and that suppresses your viral load to undetectable levels often requires a very delicate balance between drug efficacy and potential short- and long-term drug toxicities. Personally I would not risk doing anything to upset that balance. The ultimate choice is yours, but the risks of unprotected sex are not ones I would consider acceptable.

Stay well.

Dr. Bob


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