Dear Dr. Frascino, I am the one who asked about superinfection a couple of days ago. I did not want to make my story too long so I limited myself to clinical facts and my concern. The person with whom I had unprotected sex claims not to know his status (kind of person who prefers not to know) and is perfectly aware of my pos status. Yes, quite naive from my side, but I do tend to care more about others than about myself. I used to read that superinfection, although existing, was a rare factor. Now that I had those simpthoms similar to an acute infection (although part of it might be related to the ameba thing), I got better informed and found out it might not be that rare. My important drop in CD4 scared me. The fact that viral load was stable gives me hope and I wanted your opinion. I hope a routine CD4/VL test will answer the question, or should I consider another specific test to check superinfection? Anyway, the main issue in this message was to let you know that I am more responsible with others than I am with myself because you got the wrong idea on my previous message and concentrated on the responsibility issue. I am a little terrified but hopefully it will turn out fine. Thank you

Hello,

Thank you for providing the additional information. However, I must still point out you knowingly had unprotected sex with someone who "claims not to know his status." It always takes two to do the unsafe dance with no pants! This type of behavior does not reflect your statement that you tend to care more about others than yourself!

To address your specific questions, there is no readily available test to check for superinfection (outside of clinical research laboratories).

You should recheck your CD4 count and HIV plasma viral load as your next step. You must also stop putting both yourself and your partners at risk by having unsafe sex.

Dr. Bob

SUPERINFECTION Nov 9, 2009

Dear Dr. Frascino,

I am HIV+ for about 4 years and still not on meds. On my last checking, CD4 decreased from 690 from 3 months ago to 450. Viral load not changed and remains in the range of 40.000. Since I still had unprotected sex, I am fearing superinfection. I had similar simpthons of seroconversion of 4 years ago, including low fever and tiredness. In the meantime, I also acquired ameba during a trip to the far east. The ameba was now eliminated but I am still having occasional low fever and night sweat. My doctor says nothing to worry as we did not see an increase in the viral load. Because of my unstable temperature readings, plus the fact that the last CD5/VL checking was made just before my trip to Asia (so, assume prior to the ameba issue), I am quite confused and anxious. Do you think the fall of 250 points in the CD4 alone, without any change in the viral load, could indicate a superinfection or the viral load increase would be decisive for that diagnosis? Many thanks for your always clear advices.

Response from Dr. Frascino

Hello,

You have been HIV positive for four years, are not on medications and continue to have unprotected sex???? WHAT??? You seem to be only concerned that you may have acquired a superinfection. What about the risk you knowingly inflicted on your sex partners? Such behavior is unconscionable! Your doctor may say you have nothing to worry about, but I strongly disagree. You should be very worried that you transmitted your virus to your partners. I urge you to do the right thing and advise all your partners of your HIV status and encourage them to be screened for HIV. If, by chance, you've been "serosorting" (only having sex with other HIV positive folks), you are putting yourself at considerable risk for STDs (including another strain of HIV), which could negatively impact your health and exacerbate your HIV disease.

My primary message to you is to stop having unsafe sex and to notify any partners at risk. There are several reasons for a fall in CD4 counts (including your reckless behavior). I wouldn't draw any conclusions based on a single lab value, as it may be a transient anomaly. I'd recommend repeating your CD4 count and viral load in four to eight weeks to see if there is indeed a trend.

Dr. Bob