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Transmitting drug resistence
Nov 29, 2007

I read your answer on a similar question about transmitting drug resistence between boyfriends.

My boyfriend and I have the same virus, since I got infected by him. He started medication and is fully compliant. I am not yet on drugs.

My questions is about my risks to get resistent to his drugs if we do unprotected sex.

My understanding about drug resistance is that it occurs when someone is not compliant. If my bf is compliant, the level of medication should be high enough to supress the virus , avoiding resistence. Am I right?

Thank you in advance

Response from Dr. Sherer

What you say is only partly correct. First of all, I would talk to your doctor about your certainty that you were infected by your boyfriend. If your viral genotypes were done, he or she would be able to support or refute your suspicion. It is often more difficult that you might think to ascertain when either of you acquired the infection, and from whom,simply by the history.

Also, while it is true that most resistance results from poor adherence, it can also occur in a person with excellent adherence, though much less commonly.

To get to your issue, unfortunately transmission of drug resistant virus, including superinfection, can occur uncommonly even when the person with HIV on treatment is fully compliant. In other words, if your boyfriend is fully compliant, he reduces your risk of superinfection with a drug resistant virus as much as he possibly can, but he does not reduce your risk to zero.

As a result, my advice to you to ensure that you are not infected with a resistant strain is that you follow safer sex precautions and use latex condoms, rather than accept any risk of transmission.

I suggest that you talk to your doctor and his doctor about this issue and get their advice on how to proceed over time. Your doctor may have other information, like the results of resistance tests and CD4 cell count trends, that would be useful.

You also can take a few precautions to keep the risk of superinfection as low as possible. For example, if you choose to accept the risk of superinfection, you could still use condoms during the period when his viral load is still detectable, i.e. for the first 4-8 months of treatment, and only stop this practice AFTER his viral load is undetectable and his risk of transmission is very low (though not zero).


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