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My partner may start meds, What should we do?
Mar 26, 2012

I have been poz for 3 1/2 years. My cd4 hangs out around 600 my viral load around 7000. I am on no meds and my doc doesn't feel the need to put me on any. My partners doc wants to discuss him going on meds. We may have the same strain of HIV but not certain. We are in a committed monogamous relationship and no longer use protection. What are the risks of me becoming resistant to meds through his semen? Everyone I ask toes the CDC line that we should still and always use protection with each other or we could get a superbug, but I want to know about meds. Should we use protection when he tops? How about orally? And what are the chances when I top?

Thank you for your help.

Response from Dr. McGowan

Thanks for the question.

When your partner starts meds, it may indeed change the balance of things that has developed up till now. It may be that his body was not able to contain the virus as well as you have. Or that he views medication and the benfits of suppressing the virus differently than you. For whatever reason.

If he is able to fully suppress his virus to undetectable levels (which is the result in 80% or more of people on newer treatments today), the risk of transmission to you would be dramatically (96%) reduced.

If he is not able to suppress his viral load that is when the virus can mutate and have a chance to develop resistance, which could be transmitted during sex.

The relative risk would be based on his viral load...the higher, the more risk. The highest risk would be when he tops, much less risk during oral sex (unless you had gingivitis or gum disease, canker sores or bleeding). You could negotiate using condoms for the riskier sex practices until you know that his virus is fully suppressed to undetectable for 6 months or so.

Also you can discuss taking meds yourself as a very potent protective strategy against acquiring a resistant strain.

Best, Joe



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