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How safe does HIV+ couple have to be?
Aug 26, 2004

Dr. Bob,

You inspire and console many, and are appreciated by the positives and negatives in this fight.

Ok, here is my question, I have been dating another HIV+ man for over a year and we have entered a committed relationship. We are both in our 50's and look forward to a great long life together. Both of us are on a drug regiment and have undetectable viral loads. We both have a good T-cell count and both of us are very healthy.

If we live in a committed and monogamous lifestyle, how dangerous would un-protected sex be if we both have the HIV virus already, and are both compliant on our drug regiments?

We are very happy with our current safe sex practices, but are curious what you would say to this question.

P.S. Our doctors are evasive, first telling us about the risks of super infection, but then eluding to the fact that it would be unlikely.

Thanks! Curious in Boston

Response from Dr. Frascino

Hello Curious Boston Boys,

Actually your doctors are right on target. There is indeed a risk of superinfection. Cases of superinfection have now been well documented. The question of how often it occurs remains unanswered. That might explain your doctor's seemingly "evasive" comments. In reality we don't have a lot of information about the frequency of HIV super-infection because it's not all that easy to document without rather extensive and costly analysis.

Certainly the major concern is the acquisition of a more virulent (aggressive) strain of HIV, or one that is resistant to some of the drugs in your current regimen.

As two consenting adults, only you and your partner can decide if you are willing to take this risk. You mention you are "very happy with your current safe sex practices." All I can do is advise you that the risk of superinfection is real, very significant, and potentially devastating. Even though the chance of HIV transmission is decreased by having undetectable viral loads, HIV superinfection is not a risk I would not be willing to take personally.

Good luck, Boys. There may be some more information on this topic presented at an HIV/AIDS medical meeting in your hometown scheduled for February 2005. Stay posted to this site and I'll keep you posted as well!

Dr. Bob



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