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Tested Positive Last Month
Dec 20, 2002

Hye Doc, I have been going through this your column for some 2 months ago.Straight to the question, I am an African staying in Africa, I first tested positive some 1 month ago. My first question is what I hear counsellors here call re-infection. It has scared the hell out of me,I don't touch anyone including my wife who is also positive. Please explain to me the Science behind reinfection

Two, my CD4 count was 674, and VL slightly above 1000. I want to know when to start the anti-retrovirals and what to do to try and help my lenghten my life with my current viral load. This is because my son is still 2 years old and he would suffer in my absence coz of the bond I have with him. Thank You

Response from Dr. Wohl

Hi and thanks for your questions.

I think by re-infection you may mean getting infected with another 'strain' of HIV than the one you originally acquired. There has been a lot of talk about this, especially regarding the transmission of virus that is resistant to HIV medications, but in reality I must say this does not seem to be all that common, or at least hard to demonstrate.

Yet, theoretically, this is a concern. You do not want to catch a multi-drug resistant version of HIV. But, more to the point, you do not want any other sexually transmitted disease, or to give your virus to someone else either, right! The strategy remains the same - safe sex. That should keep you covered.

Regarding starting therapy. You may be very fortunate in that your viral load is low off of any HIV medications. This would suggest (using data from the US and Europe) that it will be a long time (years) until your counts drop into the range (200-350) that we in the states start considering HIV therapy. Unfortunately, there is little direct data from Africa to know if the same guidelines are applicable there.

If you are well and have no symptoms of HIV, I would follow your CD4 cell counts every few months if possible. If they do drop to around 350 or so, I would pursue HIV therapy. DW



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