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Transmission rates during acute infection
May 7, 2009

Dr Frascino,

I was just notified that a sexual partner I had 4 weeks ago is now positive. He is farily certain that he was infected 6-8 weeks before our encounter, and knows that his viral load 3 weeks after our encounter was 89,000. I was the unprotected insertive anal partner in the encounter.

I'm being tested later today, but of course I've been busy trying to ascertain my risks. I see lots of data about very low risks per encounter, and then lots of information stating that my risk from someone in the acute stage of infection is "very much increased". But does this mean the risk is still quite low in an absolute sense, or are we talking about 50-75% risks?

I know that the only real answer to this is to get tested, which I am doing, and I know that there are a lot of variables which come into play with each encounter that vary the risk. I simply wonder if anyone has any hard data on infection risk during primary infection. Thanks for your help.

Response from Dr. Frascino

Hello,

The estimated per-act risk for acquiring HIV from unprotected insertive anal sex with a partner confirmed to be HIV positive is 6.5 per 10,000 exposures. Yes, if your bottom-guy has been recently infected and is not on antiretroviral therapy the risk for HIV transmission would increase, but certainly not into the 50-70% range. You are correct: The only way to determine if you've acquired the virus is to get tested at the three-month mark. Because you've had a significant exposure to someone confirmed to be HIV positive, the CDC also recommends a follow-up test at the six-month mark.

I probably don't need to say this now, but you do realize that a thin piece of latex or polyurethane could have prevented all this, don't you? This is a very difficult way to learn a very important lesson. As I have repeatedly preached in this forum, we must assume all our sexual partners could be HIV positive and therefore take all the necessary precautions to prevent viral transmission. I hope others reading this forum will benefit from your lapse in judgment.

Good luck! I'm here if you need me.

Dr. Bob



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