Dr. Bob,

My boyfriend and I are both HIV positive. I got my HIV from him and we have the same strain of HIV as far as I know. He is on Sustiva, Viread, Bactrum and Emtriva. I have a higher CD4 count and do not need medication yet. Is it ok to have unprotected sex since we are both having the same strain of the virus ? He knows where he got his strain from and i know I got mine from him. If not, what are the reasons and what can happen and how well documented is it too?

Thank you

Hi,

Even HIV obtained form the same source can evolve differently in different folks due to different immune responses against the virus and other pressures on the virus which may cause it to mutate. Remember the gazillion different strains of HIV we now are dealing with all started form a single strain and subsequently evolved, right?

You and your boyfriend have very different immune systems. And since your boyfriend is on HAART and you are not, the pressures on the virus are very different. Consequently, you cannot assume you both still have exactly the same virus.

Next, what about superinfection or re-infection? Yes, this phenomenon has now been scientifically well-documented. What we don't know is exactly how often it occurs. Take a read through the archives of this forum, as I have discussed this topic many times in the past and the information has not changed.

The bottom line is that yes, there is a risk; yes, that risk has been scientifically documented; and yes, superinfection can have deleterious (even catastrophic) consequences. Only you and your partner can decide if this is a risk the two of you are willing to take. I, for one, certainly would not!

Stay well.

Dr. Bob