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Should we abstain from sex for now?
Mar 25, 2006

I am 44, had been monogamous with my husband 13 years, until an affair in late Dec./early Jan. when hubby and I separated for a short time. We got back together 1/13, and on 1/31 I got sick. Fever, extreme fatigue, malaise, rash on my chest, muscle aches, nausea & some vomiting, just generally felt like crap. Diagnosed with pyelonephritis, but didnt't get better on antibiotics. Had a CBC, which showed WBC of 2000 and shift to the left, I think - many bands (??). Further labs showed elevated liver function. Hematologist worked me up for lupus (negative, including ANA and double strand DNA), hepatitis, etc. I did a lot of checking on-line, and since it was about 3 weeks after a lot of sex, including anal, with this other man, it looked like acute retroviral syndrome was possible. Initial HIV test was ELISA positive, Western Blot indeteriminate - that was Feb. 8th, got results 2/28. Had second test drawn 2/28, got results 3/13 - ELISA positive, Western Blot positive, rapid test positive for HIV-1. I got the name of a few doctors from our local AIDS program, and went to one Wed. evening. He is an OB/GYN and primary care physician, with 19 years experience dealing with HIV. He talked to my hubby and I (hubby is negative thus far)and advised us against any sex at this point. He said 2 months after exposure I am just too highly infectious, and the 90% protection from condoms isn't enough right now. Keep in mind at this point, no viral load or CD4 numbers yet - those were drawn Thurs. He said my immune system is just now starting to win the fight against HIV, as indicated by an elevated protein level, and CBC returning to normal.

Have you ever advised against any sexual intercourse in the early stages of HIV infection? Is this really the best thing to do for now?

Response from Dr. Frascino

Hi,

Sorry to hear about your recent HIV diagnosis. Regarding HIV-transmission risk, it is true that "infectiousness" is higher when plasma HIV viral load is higher (and vice versa). At this point, you and your husband are a magnetic couple (one positive, one negative). You will need to realistically redraw boundaries for safer sex. Communication is key. Discuss what each of you feels is safe (or unsafe) based on your individual comfort level and the medical facts. Create a safer-sex ritual you both agree to. It's important to note many magnetic couples (including yours truly) have very successful and satisfying sexual relationships. Use the information on this site and related links to review the sexual risk of various sexual activities.

Do I recommend against all sexual intercourse in the early stages of HIV infection? No, I recommend safer sexual practices and negotiated risk for all magnetic couples at all stages of the infection. Review the information in the archives of this forum pertaining to magnetic (serodiscordant) couples.

Good luck to both you and your husband.

Dr. Bob



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