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drug resisstance
Sep 28, 2007

hi i would like to know how drug resistance would happen in my sitchwashin im on atripla and my bf is not take any meds yet can he become resistance to atriprla and if is doctor put him on the same hiv meds hase me could we have unprerted sex ty zack

Response from Dr. Sherer

I think you are asking two questions: First, whether you, who are on an Atripla-based ART regimen, are at risk of transmitting an atripla-resistant virus to your boyfriend who is HIV infected but not on medications; and second, if, when your boyfriend is put on ART, whether, if he is put on Atripla, you would then be able to have unprotected sex.

The answer to the first question in general is yes, transmission of drug-resistant virus is possible between one HIV+ person who is on ART and another HIV+ person who is not on ART. This phenomenon, called 'HIV super-infection', is well-documented. Fortunately, it is uncommon, and there is some evidence that infection with HIV itself causes some protection against superinfection. But there is more to this story; the risk of a super-infection from you to your boy friend would be substantially less if and when, and for as long as, your viral load is fully suppressed to a level below the detection of the viral load assay, e.g. less than 50 copies/ml. Note! Even though the risk is reduced, it is not zero, even with full viral load suppression.

So the implications of this answer are that you can lessen the risk of super-infection by having excellent adherence as prescribed by your doctor, and by maintaining a fully suppressed viral load. Of course I encourage you (and your boyfriend if and when he gets on ART) to maintain excellent adherence and take full advantage of your access to ART.

And another implication of super-infection is that, even if you succeed in maintaining a viral load below detection, there is still a small but real risk of transmission, and so I would recommend that you and your partner continue to use condoms, in order to further reduce the risk of super-infection. I suggest that you talk to your doctor about your question and this response.

If and when your boyfriend is put on ART, there are good reasons to choose the same regimen that you are taking, but that would not change my advice above regarding continuing to use safer sex practices. Either of you may develop resistance mutations, even in spite of excellent adherence, and then either of you would be at risk to transmit drug resistance to the other.

I do not mean to minimize the difficulties in always using condoms and following safer sex practices. In my practice, I do have patient couples who, having heard all available information about the risk of superinfection while on ART, have taken the following steps: 1) they have worked hard to maintain near-perfect adherence and achieve viral loads below detection for prolonged periods of time, and THEN 2) they have chosen together to accept that risk of super-infection and practice unsafe, unprotected sex. Consenting adults can make this decision, though I do not support it, and I always try to encourage them to find ways to be intimate and sexy with latex. As above, I strongly encourage you and your boyfriend to talk to your doctor(s) about this issue and get their advice.


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