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HIV superinfection labs

Jun 8, 2014

Hi Dr. Holodniy,

I have a couple questions about HIV superinfections. Please bare with me, because I realize that for these questions, there are very simplistic situations that don't take into account a multitude of different health, environmental, etc. factors. These questions basically build off of one another.

1. A situation in which an individual that's been living with one HIV subtype for 1 year - let's assume that they have a CD4 of 500, an undetectable viral load, and have been on HIV medications since they were diagnosed, where they had an initial viral load of 100,000 and CD4 count of 300 - is infected with another HIV subtype. Given that this individual is on HIV meds, would they have to worry about this new subtype causing a detectable viral load during the acute infection stage?

2. If that individual was on a one a day-one pill (Atripla, for example), would this mediation be enough to control both HIV subtypes or would they have to take more meds to control these subtypes?

3. Is it ever possible that since that individual - prior to being infected with the new subtype - has effectively controlled their initial subtype to an undetectable viral load with the help of meds, that the HIV antibodies from the first subtype might actually help this individual in helping to control the new subtype?

I hope those made sense

Thank you

Response from Dr. Holodniy

1. Yes a detectable viral load is possible, particularly if the secondary strain is resistant to one or more of the HIV meds the person is currently taking. 2. See answer to #1. An HIV resistance test would be helpful in determining whether the additional strain is susceptible to the drugs in Atripla. 3. Great question. We don't have enough information about the natural history of this phenomenon or how often it happens. Only some people come to medical attention and of those, very few are studied in any great detail.


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