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love and different virus types?
Dec 6, 2004

I am becoming involved with another hiv+ man. He has been hiv+ for 15 years and I have been for 5 years. my virus is wild type (no resistances to any class of medications), have a viral load of 650 u/ml pretty consistently and t cells counts of 375. he has developed resistance to nukes and non-nukes, is only taking protease inhibitors, has an undetectible viral load, and t cells of 600 pretty consistently. We are planning on becomming sexually involved soon, talking about the pros and cons of not using condoms. I am wondering about the impact of his virus type to mine, if we decide to enter into a long term relationship. he's 49 and i'm 55, and we are expecting to be together, until one of us, lovingly sends the other to his final rest.

from: falling for each other with our eyes open

Response from Dr. Sherer

While there is credible evidence that 'super-infection' occurs, it is strikingly rare in the world's literature.

By 'super-infection' I mean when an HIV+ person acquires a second HIV infection through unprotected intercourse or other means; this is the issue you and your partner (and many HIV+ couples around the world) are dealing with.

So there are smart virologists who have gone looking for clear evidence that super-infection occurs, and occurs frequently, but it has not been easy to prove. More commonly, as recently shown by Mark Wainberg of McGill University in Montreal, what you see in a given HIV+ individual over time is striking homogeneity of their viral makeup (in the absence of ART drug pressure on the virus).

However, I would not be reassured by this observation. There IS evidence that super-infection can occur, and some anecdotes of people who are stable and doing quite well over time who, upon becoming infected with a different virus, including one containing resistance mutations, suffer from rapid CD4 cell decline and loss of virologic control.

Surveys of seropositive and serodiscordant couples suggest that many choose to have unprotected sex (as many as 20-30%). In some cases, the decision is made to risk being unsafe only in the presence of excellent viral control, in which the risk of transmission is lower, though not absent.

I advise my patients to play safely, and that's my advice to you. You can be satisfied and sexy while using latex, as millions of heterosexual and homosexual Thais (and others) have shown.

I can't subscribe to your fatalism. Nothing that I've experienced about HIV deaths and prolonged illnesses among my patients or friends invokes the word 'lovingly'. Please be forewarned, this process can be rough for both of you, the sufferer and the survivor. Why risk that? I would prefer that you play safe with latex and take HIV superinfection off the list of problems that you might cause each other. Better to lovingly increase the odds that you wake up together tomorrow and 10 years from now.

resistance built up too soon
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