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Viral Resistance of Newly Infected Partner
Nov 24, 2005

My question is regarding viral resistance in HIV transmission from a long-time HIVer to a newly infected person. My friend has been in a relationship with an HIV+ partner for 10 years. His partner has been HIV+ for approximately 12 years. Unfortunately, despite 10 years of testing negative my friend was recently diagnosed with HIV. My question is pertaing to viral resistance. Throughout the course of their 10 year relationship my friend's partner has been receiving treatment for HIV. I am not sure specifically as to what kind (though I do know that throughout the course of their relationship he has switched medications several times). Does this mean that my friend has been infected with a very resistant strain that will not respond to the medications his partner has already used? Or will his disease merely progress in him the same (or similarly depending on his body's response)as it has in his partner? Thanks so much for your help.

Response from Dr. Sherer

In recent surveys of recently infected patients in the United States and Europe, the prevalence of resistance to at least one drug is around 10% - so the possibility of acquiring a drug-resistant virus is a real one in settings where treatment (ART) has been available for many years.

While I appreciate that you are seeking information as a friend of this couple, I would caution you that this is complex and intimate territory for these two people. Your interest may not be welcome, and your secondhand information may well be incomplete, if not inaccurate.

For example, it may be wrong to assume that the source of the recently infected partner's HIV is his partner.

IF the virus that the recently infected partner acquired did come from his long standing HIV+ partner, it may well contain some or all of the resistance mutations that he has acquired after many years of ART. It may not contain them all, because some drug mutations become 'archived', i.e. present only in minority populations, in an individual if there is no longer drug pressure from his current ART to drive the majority population virus to maintain that mutation.

For example, if an initial regimen contained an NNRTI such as efavirenz, and then resistance developed and a second line regimen containing a protease inhibitor were used, the mutation that causes NNRTI (such as efavirenz) resistance may no longer be present in the dominant population, and hence might not be transmitted.

I urge you to take this line of inquiry no further without ensuring that both of your friends welcome your interest, and your entry into what is a private matter between them.

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