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Two Sexual Encounters
Jul 21, 2004

To whom it may concern,

I've been Hiv+ for a few years now and I have a t-cell count(cd4)close to 1200 and a undetectable viral load under 400 copies per millimeter.

I made love to this woman twice and ejaculated inside her vagina. What are the chances of transmitting (probability) the virus to her considering my viral load is so low and my t-cell count or cd4 cells are around 1200?

I'm prepared to break all ties w/ this lady.

Thanx,

Response from Dr. Frascino

Hello,

"To whom it may concern?" What??? Is there someone here other than me??? Oh well, guess you'll have to settle for my response.

First off, the mere fact you are asking me (or whomever) what the "probability" is of transmitting your HIV to your partner as a result of unprotected insertive vaginal sex indicates that you realize there is at least some risk, despite your less-than-400 viral load and high T-cell count, right? That, of course, brings up the question of why, if you knew there was a risk, you would knowingly expose your partner -- twice. I'm not trying to be judgmental; I just wonder what rationale you used to convince yourself that this would be OK.

Regarding your specific question, the overall risk per episode of receptive vaginal sex with a partner confirmed to be HIV positive is 0.1% to 0.2%. That your viral load is low might, in some situations, decrease that overall risk. However, the most important fact to realize is that despite low viral load (and/or high T-cells), a very real risk of HIV transmission remains. Your partner will need HIV testing out to six months from the last exposure. (The six-month window for testing is recommended by the CDC because there is certainty that she had a significant exposure to someone confirmed to be HIV positive).

You state you are prepared to break all ties with the lady. Hmmmm . . . is that because she agreed to have unprotected sex with you?? Well, whatever the reason, she does need to be informed that she has placed herself at significant risk and needs HIV testing.

Good luck to you both.

Dr. Bob



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