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Why didn't I get HIV
Apr 4, 2006

Dear Dr. Bob, I have read your forum for the first time tonight and I already gotten an education! You seem very knowlegable, so maybe you can answer questions that none of the doctors my husband and I are seeing (an internist, a hemotologist, a liver specialist, a fertility specialist and an OBGYN) can answer. My husband is HIV+; I am negative. We were together for four years before my husband's diagnosis. When he was diagnosed, he was told that his high viral load and low CD4 count (168) indicated he had contracted the virus 8-10 years earlier. During those four years, we rarely used condoms--although we have since my husaband's diagnosis. My husband has now been on meds for 3 1/2 years and has an undectable viral load and his CD4 count has reached 450 (pretty good, since he also has HVC and treatment suppressed his CD4 count for over a year). We are now trying to have a baby, but don't see how we could afford IVF with sperm washing. We feel there has to be a reason that, during our first four years together when things were hot and heavy, I was on the pill and we almost never used condoms, I never contracted HIV. Do you know of any documented reasons why I did not contract the virus? Is there any reason to believe it is impossible and/or unlikely that transmission would take place between us when it didn't during the four years we didn't use condoms? Have you heard of a dual mutation of the CCR5 co-receptor that makes transmission of HIV nearly impossible? I've also read it is possible for the HIV virus to not be present in a man's semen--is this true? Do you know of other situations like these that could answer my questions? Your input would be greatly appreciated. A grateful, but confused neggie

Response from Dr. Frascino

Hello Grateful but Confused Neggie,

You mention you and your husband have seen "an internist, a hematologist, a liver specialist, a fertility specialist and an Ob/Gyn". The glaring omission is an HIV specialist! If your husband is not seeing an HIV/AIDS specialist, he should establish care with one as soon as possible. Coinfection of HIV and hep C can be difficult to manage. The HIV specialist would also have been able to answer your transmission question. Basically, the answer is that HIV is not all that easy to acquire (thankfully!). The vast majority of exposures do not lead to viral transmission. The estimated per-act risk for acquiring HIV from unprotected receptive penile-vaginal intercourse with a partner confirmed to be HIV positive is 10 per 10,000 exposures. Given those statistics, you can probably see that with some degree of luck you could very well have been exposed multiple times during the four years of "hot and heavy" and not contracted the virus. Certainly multiple other factors could have come into play as well viral strain, viral load, host immune response, etc. The take-home message is that stories like yours are not at all uncommon. Does this mean you can have unprotected sex and not worry about becoming HIV infected? No, it certainly does not. Each and every time you had/have unprotected sex with your HIV+ husband, the risk remained/remains the same. Some folks are as unlucky to get HIV with only a single exposure; others, like you, have had multiple exposures, but luckily managed to stay HIV negative so far.

As for the other issues you raise such as the dual mutation of the CCR5 co-receptor, that story is still unfolding. The levels of HIV can be different in semen compared to blood, but usually the levels in these two compartments run parallel and follow each other closely. Finally, if you are considering becoming pregnant, sperm washing and IVF is the safest method to protect your health and that of your child. Spend some time reading through the archives of this forum, as I have discussed many of these topics in great detail in previously posted questions.

Good luck to both you and your husband.

Dr. Bob



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