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HIV Drug ResistanceHIV Drug Resistance
           
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Re-infection Causing resistance?
Jun 22, 2002

I keep hearing rumblings about resistance being caused by re-infection (unsafe sex) with people who are drug-resistant. My doctor originally said this hadn't been proved; i.e. if you were originally infected with a non-resistant virus & faithfully took your medications, you would not pick up a resistant virus through sexual contact. Now, he's changing his mind, due to some information from a Seattle conference. HAVE they finally settled the question of passing on resistance to other non-resistant positive people sexually? What about if two monogamous partners who are on the same effective drug regimen? Would their unsafe sex cause a resistance to happen if they were both non-resistant? Everyone asks questions about developing resistnce through incorrect adherance to regimens, yet I'm much more worried about becoming resistant through other means; I can take my pills correctly, but I can't control what other sex partners do. Can you shed any light on this?

Response from Dr. Little

I agree with your doctor - there is increasing evidence that superinfection (that is - re-infection with a different stain of virus is possible) does occur. The data is still a bit incomplete, but it does appear that superinfection may occur more often than we originally thought. If superinfection can occur, then I see no reason to think that in the right (or more accurately - wrong) circumstances, the new virus might also carry drug resistance mutations and cause a change in the recently super-infected person's clinical course.

It is my opinion that the available data most strongly support the possibility of super-infection during the earliest days of HIV infection (i.e. primary HIV infection), but I think we still need more studies to identify how often this really occurs.

In terms of how big a problem this is in chronically infected persons who are taking their medications regularly - I do not believe that superinfection with drug resistant virus is a major concern. That is, the fact that we scientists have had such a hard time finding it, suggests to me that it is not that common. Also, just because the drug resistant virus is causing problems in the other person does not necessarily mean it would be readily transmitted to you, or that the drugs you are taking wouldn't prevent re-infection altogether. So, we don't have all the answers you want yet, but I hope this helps.


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