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FINALLY some good news...
May 18, 2007

Hey Dr Wohl!

Sorry I missed the technical discussion you recently suggested. :( I was already scheduled to be out of town for work and had to miss it. I'll look for similar events in the future!

To recap, I was diagnosed HIV+ back in DEC, and have been establishing my baseline numbers ever since. My CD4 is running at a stable 19%, but my VL has been in the 100k-999k "band" (yeah, I'm that "band" guy).

Because of the high VL my Dr and I decided to start treatment, so I signed up for the MK-0518 trial. As part of that they did both genotype and phenotype assays.

FINALLY SOME GOOD NEWS!

The Genotype came back negative for all matches to resistant strands! I will hopefully get the pheno-type back in the next day or two, and hopefully see the same non-resistance to the various meds.

I think not so subconsciously I've been trying to psych myself up for more bad news.

Being infected today as compared to 25 years ago has got to be a double edged sword. The good part is that the treatment has come SOOO far and people are living so much longer. The bad part is the fear that the chance of being gay and infected with a non-resistant strain has gone down as more time has passed. My thinking was that the majority of people are finding out sooner, and are starting treatment that is very effective against the non-resistant strains, therefore what they are more likely to pass on to someone else is a more resistant strain. So my anxiety has been fixated on the fear that I was at much greater risk of having been infected with a resistant strain.

Looks like my anxiety was misplaced.

Is there any correlations that have been researched regarding transmission of the disease that are based on the "prior-knowledge of sero-status" of the "passer"? What about research around the percentage of "resistant" strains are being passed as compared to non-resistant?

THANKS FOR ALL YOUR WORK!

Response from Dr. Wohl

Glad for the good news. I am unaware of any data that indicate whether the person who transmitted HIV knew of their infection. It would be hard to conduct such research given most people becoming infected may not know exactly who gave it to them and many of those who do did not know their partner was positive at the time. It is also a challenge to track down those who passed the virus on.

We do know that as many as 28% of the million or so in the US with HIV infection are unaware they are infected. We also know that many people may transmit the virus soon after they catch it -- during the acute phase of infection when viral loads are very high and the behavior that led to infection is likely to be repeated.

In US and European cities, about 15% of new infections are with drug resistant HIV. Some places it is higher and some lower.

DW



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