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Superinfection
Jun 14, 2007

I read Dr. Sherer's response to this question: "the important take home point for people living with HIV is that you can be superinfected with a different strain of HIV, and there are cases documented in which a persons stable clinical course was disrupted because of the acquisition of a viral strain that was resistant to the patient's current regimen."

But isn't it important to mention that almost all cases of superinfection in the U.S. have occurred in the first two years after the original infection, most in the first year? Many experts have postulated that superinfection is not a signficant risk for those of us with long-term, established infections.

While it's important to state the risks for those of us with HIV, isn't it also important to clearly define the level of risk?

Mark Milano

Response from Dr. Sherer

Hi Mark - It certainly is important to define the level of risk, and if possible to quantify the level of risk, but its not possible, given the quality and amount of available data in the US. I don't share your confidence in the observation that most cases have occurred in the first two years after the original infection. It has certainly been shown that superinfection among individuals with B clade infections is difficult to prove...but that is a different point.

Recent data from a cohort of discordant couples in Africa found that the immune response from people who became superinfected - i.e. the presence of neutralizing antibodies and cytotoxic T cell responses - had no effect on the risk of superinfection. This would suggest that superinfection could happen at any time during active HIV infetion.

So my bottom line is that superinfection has been well documented, and it has been shown to be a potential threat to an individual's clinical course.

I can only support your statement that some experts think superinfection is very uncommon, and low risk in chronically infected individuals. I don't share that view, because I don't think we have enough relevant data on which to base that conclusion.

I suggest that you talk to your physician about these issues.


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