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Cause, Progression and Rebound
Apr 19, 2007

I in my mid -thirties and tested positive one year ago. I am unsure as to the source of my infection. I am heterosexual and have been in a monogamous, married relationship for 4 years and she is negative. There was one encounter just before I met my wife that could have been the source, but my wife and I have had unprotected sex prior to my diagnosis hundreds of times.

I was involved in a trauma that resulted in blood products from over 100 donors 9 months prior to my diagnosis. Look-back can back clean on all but 12 donors who could not be traced down.

At the time of my diagnosis, my absolute cd4,cd% and VL was 56, 20%, and >750,000 respectively. I immediately started on Truvada and Sustiva. I have been tested every 3 months since with results as follows: base :56,20%,<750,000 1 month:424,33%,1250 3 month:401,36%,<400 6 month:491,41%,<400 9 month:481,40%,<400 12 month:514,41%,<400

I have several questions.

1) What are the chances of being infected for 4+ years and NOT transmitting it to my wife during regular (at least weekly) unprotected sex? 2) Can she be tested for the mutation that makes her less-susceptible to infection? 3) How do my results relate to expected and best case scenarios? 4) Can a severe trauma resulting in massive blood transfusions (12 units in 1st hour, 30 units over one month period) cause rapid onset of AIDS? 5) Finally, how effective are the sprem washing techniques? Can we safely have a baby?

As you can see I am quite confused. I have a lot of guilt for simply exposing my wife, even though she is still negative. I know this is a lot of information and questions, but I need some help.

Sincerely, Confused, Conflicted and hoping for a normal life.

Response from Dr. Wohl

Dear CC,

There are many couples of HIV discordant (one is HIV+, one is HIV-) where, despite many exposures the negative partner stays negative. This could be due to luck, genes that reduce vulnerability to HIV or maybe factors to do with the virus.

I can't see a reason to test your wife for the mutation associated with relative resistance to HIV infection. If she has it, it should not lure you to let down your safe sex guard. If she doesn't it will not help this guilt of yours.

Your success with HIV therapy is great. You should be estatic.

Rapid progression after infection has been described. It is possible.

Ah, sperm washing. It seems to be very effective. It is also very expensive.

Lastly, talk with your doc. He/she should be the cure for your confusion.

DW



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