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Pos to Pos superinfection risk?
May 5, 2008

Hi Dr. Bob, My partner and I are both pos. He is on meds doing fine and undetectable. I am not yet on meds. Neither one of us has shown any resistant virus. I read a lot about how a pos couple still needs to use condoms to prevent superinfection. How often does this happen? We have been together 16 years and like it much better going bare. It not only feels better but it's more intimate too. Would it be safer if I went on meds also even though my numbers don't require it yet? You seem to always give good advice on here and I will trust your answer on this. Thank you.

Response from Dr. Frascino

Hi,

Yes, superinfection/reinfection is real. However, we really do not know how often dual infections actually occur. (It's a difficult thing to sort out in the laboratory.) It appears to occur much less frequently than we initially feared. It also seems to be more common very early in the course of infection. I wish I could give you a more specific answer, but unfortunately that's all we know so far.

Regarding initiating HAART earlier than the current guidelines recommend (CD4 count of 350 or below), we would recommend starting early for magnetic couples to decrease the risk of HIV transmission to the negative partner. Can this same strategy be applied to poz-poz couples? No one knows, but there is at least a theoretical reason to consider it. In addition, recent observations on HIV's natural history and pathogenesis support much earlier intervention with antiretrovirals. Consequently you may have two theoretical reasons to consider staring.

Whatever you decide, good luck to you both.

Dr. Bob



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