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Resistance to Meds
Aug 27, 2007

My boyfriend found out he was poz about 2 years into our relationship. He failed to tell me because he was afraid I would hate him. I found out because I found his meds and knew what they were for as my father died infected with AIDS. After discussion, it appears he had been taking medications for a few months before I found out and we had been having unprotected sex. How likely is that to affect my resistence to the meds he is taking if I am prescribed them. He is on Kaletra and Sustiva. All of my labs have shown that my CD4 count is increasing steadily. I am on on the plus side of 700 as of March of the year. My viral load is somewhat high according to the doctor. I have not yet been prescribed medications but I am concerned for the future.

Concerned in Texas

Response from Dr. Sherer

Superinfection - i.e., acquiring a different HIV strain from another person when you already are infected with HIV - is well documented, i.e. it has been well proven to occur, but it is surprisingly uncommon.

You are right to be concerned, because you could acquire his virus and whatever resistance mutations he has. Tranmission of HIV with at least one drug resistance mutation is now common in the US, occurring in an average of 10% of patients with new HIV infection.

I don't have enough information to answer your specific question, however, but you and your doctor, and he and his doctor, could offer a clearer picture of your risk. It would be helpful to know what was happening with his clinical status during the time of your exposure. If he had been well controlled on his regimen during the entire time with a viral load below detection, the risk of your acquiring his virus would be very low. If, on the other hand, he was uncontrolled and viremic, your risk, though still VERY low, would be somewhat greater.

The risk also may vary by the type of resistance mutation that his virus has (if any). He is currently only on a protease inhibitor and an NNRTI. What resistance mutations - if any - is his virus known to have? Has he ever had a resistance test, and, if so, what did it show? Some resistance mutations may be more transmissable than others.

You are describing events that happened two years ago 'when you were having unprotected sex.' What have you been doing since you found this out? My advice would be to be safe and use condoms to prevent mixing each others viruses, for exactly the reason that prompted your email question. If you have been safe for the past year, for example, and your CD4 cells are still high, and there has been no major change in your viral load, then your risk may be lower. You and your doctor should do (or repeat) a resistance test (if your viral load is above 1,000) in order to see if your virus has changed unexpectedly, and to see if you have any resistance mutations.

So, in sum, there is a small but real risk of superinfection that should lead you and your boyfriend to be safe exclusively with each other; your risk is small, but you can investigate it further with some more information with your doctor and his doctor and treatment record; and you can do (or repeat) a resistance test to look for new or unexpected mutations.

Talk to your doctor, and have your boyfriend do the same with his.

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