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Drug resistance
Jan 23, 2006

The person x married and HIV positive person started ART 2 years back .his wife as well HIV positive not yet started the tratement because she is in good condition and her CD4 count >350. Is there any possibilities of transmitting resistance viruses to his wife During sexual intercourse ?

Response from Dr. Sherer

Yes. We know that drug resistance mutations can be, and are being, transmitted to people HIV+ who have never been treated before, as well as to HIV negative people.

Superinfection, i.e. an HIV infected person acquiring a second new strain of HIV infection, is now well proven, but there is evidence that it occurs very uncommonly. Nonetheless, we advise HIV+ people to use barrier protection, i.e. condoms, during sex for two reasons: To prevent HIV negative or positive partners from acquiring their partner's virus, and to prevent the HIV positive person themselves from acquiring a new, and possibly resistant, strain of HIV.

Note that a person who is successfully contolled on ART with a viral load below detection has a substantially reduced risk of transmitting the virus, as compared to someone with a very high virus load. However, even with a viral load below 50 copiesml, transmissions have been documented.

So to return to your situation: The best advice is for a discordant couple, i.e. one in which one partner is HIV+ and the other HIV negative, is to use condoms all the time. Similarly, the best practice for two HIV+ people who are both HIV+, but only one is on ART, is also to always use condoms. Some couples choose to accept the risk of transmission, or the possibility of the transmission of a drug resistant strain, once the HIV+ individual on ART has become undetectable, but that decision carries a higher risk of transmission.


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