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Is Poz-Poz sex safe?
Oct 31, 2001

Can you please tell me what the latest opinion is concerning sex between two HIV positive, but otherwise healthy, people? Do we have to use condoms? Is there really a risk of "reinfection"?

Thank you.

Response from Mr. Kull

The actual evidence for or against reinfection is limited and, as far as I know, is not based on larger research studies with humans. Currently researchers in San Francisco are recruiting people for a large-scale study on the reinfection or superinfection issue (http://www.thebody.com/atn/356/superinfection.html). There have been case reports that either confirm or deny reinfection, but most experts say that if reinfection happens, it seems to be a rare ocurrence. The effects of reinfection are also not clear.

When HIV is transmitted, it theoretically retains the genetic code unique to its strain. If the HIV strain is resistant to certain antiviral medications, then it's possible that it would remain resistant to the same medications regardless of the host (person). This has been documented in drug naive, recently infected people.

Could a drug-resistant strain "dominate" the original strain that is established? Could reinfection accelerate disease or cause drug failure? At the recent Conference on Retroviruses and Opportunistic Infections, the first reported case of super-infection in an HIV+ man was presented. After eight years of non-progressive HIV infection without any antiretroviral treatment, this man had a rapid increase in viral load and decrease in CD4+ count. The researchers wondered if the change could be associated to a second infection by an HIV+ sexual partner. His sexual history pointed to an unprotected sexual encounter with an HIV+ man with rapidly progressing HIV. The researchers found similarities in the genetic codes of HIV in both men after they had sex, and no similarities prior to their sexual encounter. Even though this is only one documented case, the study strongly suggests that reinfection is possible (see http://www.thebody.com/step/retro2000/march4.html).

An animal study exploring reinfection introduced a different strain of HIV to chimpanzees with asymptomatic HIV infection. A PCR test showed that the original strain remained dominant. Strain specific PCR testing showed that the newer strain was established, but did not have any effect on the chimp's viral load. It's not clear if this subordinate strain could ever become dominant under particular conditions. The authors suggest that super-infection could happen more than we currently know because we really haven't been looking for it with strain specific PCRs.

Take a look at the article called "The Reinfection Debate" which reviews the information available and expert opinions(http://www.thebody.com/asp/june99/reinfection.html).

RMK



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