I have tons of questions on superinfection... so I decided to go to the PROs!

1- Are there any documented cases of Superinfection in people currently taking medications?. I have been reading a lot about superinfection on your website, but I cannot find a documented case where the person was currently on medications. All articles say the people superinfected were not on medications or they were and they stopped during the time where superinfection occurred.

2- Are medications like Atripla (since it is supposed to attack the virus at different stages) better at preventing a superinfection?

3- Since Atripla is a combination of 3 medications. Is the only way to be superinfected while on Atripla, to be exposed to a virus that is resistant to all 3 medications? or are there other factors to take into consideration?

Thank you for your hard work and for all your support!

Yes, superinfection has been documented involving individuals on treatment.

In general, superinfection is less likely when the individual on treatment has a viral load below the level of detection, but the risk of transmission is not zero, i.e. transmission can occur even when the viral load is below detection. This is due to the fact that the impact of treatment on virus in the blood differs from its impact on virus in sequestered sites such as the gonads and the central nervous system. Individuals with excellent control of viral replication in their blood do not necessarily have the same level of control of virus in the genital tract. At present, the available evidence suggests that any effective ART regimen - whether it is Atripla or another - has a positive impact on the reduction of the risk of transmission. Atripla is not superior to other regimens in this regard.

The answers to your last question are that the presence of resistance to one or more of the drugs in Atripla would increase the likelihood of superinfection, but that is not the only important factor, as noted above.

My approach to the potential risk of superinfection is to offer as much information as possible to patients so they can make their own informed judgments. I they ask what I think they should do, I encourage continuing safer sex practices, i.e. sex with latex, as the best way to prevent transmission and superinfection with resistant virus. I offer the evidence that transmission is far less likely when individuals are on treatment and fully suppressed, and that this is another important reason to practice excellent adherence and to take every dose of ART as prescribed, in order to further reduce the risk of transmission.

I have had HIV+ couples in my practice who chose to accept the risk of superinfection and have sex without latex, and I accept that and offer what further assistance I can, even as I discourage the decision.

Finally, I urge you to take your questions and concerns to your doctor and discuss them fully, along with these suggestions.