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Comment on "Abstain from sex for now?"
Mar 28, 2006

Hello, Bob.

We are in virtually 100% agreement on almost all issues. (I visit your forum regularly.)

Why would you not recommend abstinence during the first few weeks of HIV, when there is reliable reason to believe infection is indeed new, and viral load likely is high? As you know, HIV transmission is disproportionately common during acute infection.

H

Response from Dr. Frascino

Hello H.,

I've blocked out some of your original question to insure confidentiality but still allow me the opportunity to respond briefly to your concerns.

You ask why I wouldn't recommend abstinence during the first few weeks of HIV infection. The questioner was infected in December or early January per her history. That's approximately three months ago. Clearly she is beyond "the first few weeks" of HIV infection. So when should a specialist suggest it's safe for magnetic couples to engage in sex? A few weeks? A few months? When the viral set point is reached? When they have started HAART? Only when HAART has driven plasma RNA to undetectable levels? See what I mean? I believe it is much more important to explain the concept that "infectiousness" is higher when plasma HIV viral loads are higher and vice versa. And this is precisely the information I gave to the questioner. As you know, HIV replication can increase for a variety of reasons development of drug resistance, intercurrent infection, poor compliance with medications, etc. giving folks the idea sex will be safer several weeks from now can be misleading and may not even be true. Not all patients have access to (or can afford) frequent PCRs to monitor viral loads, and I don't believe scheduling one's sex life around these laboratory tests is practical or logical. Learning and adhering to safer sexual techniques, on the other hand, will prevent HIV transmission no matter what the plasma HIV viral load happens to be at that moment in time.

Regarding your comment that "HIV transmission is disproportionately common during acute infection," the reason this is true is that many folks who have been recently infected do not know they are HIV positive and continue to have unprotected sex. Acute infection statistics have absolutely nothing to do with the reliability and efficacy of condoms! Whether the viral load is undetectable or 10,000,000, HIV cannot permeate intact latex. Consequently, our message needs to be one of HIV prevention based on what we know works in all situations, rather than hedging one's bets that sex might be safer a few weeks or months from now.

Although I appreciate, understand and respect your opinion, I would not change my advice to the questioner. I can also assure you that as part of a magnetic couple myself, I have given these issues considerable thought and very much practice what I preach.

Thanks again for your comments. I'm sure our paths will cross one of these fine days and we can debate these and other issues over a cappuccino.

Dr. Bob



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