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CCR5 Mutation Testing
Sep 25, 2009

thebody.com recently released an interview with Jeffrey Laurence, M.D. about the Berlin Patient effectively being cured of HIV. The article was very informative. On one hand it fills those whose lives are touched by HIV with hope that a cure can be filled, and on the other with despair because for those of us living in the U.S. our healthcare system is greatly slowing the process because of financial reasons. I am writing to ask you a related question about prevention that wasn't touched upon in the article.

I am the negative half of a magnetic relationship. I made the decision to stay with my partner after his diagnosis a year into our relationship, and truly believe I made the right choice. We have a wonderfully happy life and care deeply for each other. We have always practiced safe sex, hence me being negative a year in, but there is still the inhibition and worry caused by his fear of infecting me. I by no means want to be infected, but I long ago came to terms with the possibility that it could happen to anyone, knowingly in my situation or not, and that I would use safe practices and not let that fear inhibit me. My partner however often suffers greatly from fear of an accident that could infect me. We have discussed it with our doctors and counselors, he understands my views, and realizes that our safe practices limit the possibility of transmission, but like many HIV+ folks as I understand it, he still continues to worry. Enough so that if often affects his ability to be sexually intimate. My question is this. If the delta32 CCR5 mutation effectively blocks HIV transmission is there a way for people in my situation to get tested and if so, what tests would I ask for, and about how much would those tests cost. I realize that the effects of the general population testing for it could lead to the people with the mutation no longer feeling like safe sex is needed and spreading other dangerous STD's so I can see it's downside, but for people in my situation it could help us, and our partners, feel more comfortable in our sex lives knowing that our own bodies are offering us some protection.I realize the chances of actually having the mutation are low, but I am of european descent, and it seems like it couldn't hurt to do something that would help ease my partners mind. It could also help add us to some kind of registry for donors, because I know if I were one of the mutation carriers I would donate marrow to someone who needed it even in they weren't my partner, in order to help find a cure or vaccine for everyone.

Response from Dr. Frascino

Hello,

Screening for the delta 32 CCR5 mutation remains primarily a research tool at present. (See below.)

Regarding your partner's concerns, review the information in the chapter on magnetic couples in the archives of this forum. I'll reprint below a small sample of the information you'll find there dealing with harm-reduction measures for magnetic couples. I too am part of a magnetic couple. Steve (Dr. Steve, the expert in The Body's Tratamientos forum) is my HIV-negative mate. We've been legally married for a year, but have been partnered for 16 years. Our sex life remains, well, in a word, "hot." Knowledge and communication is key. Happily-ever-after is indeed possible for magnetic couples and that includes hot fusion sex!

Dr. Bob

HIV/AIDS Resistance Gene (DELTA 32 mutation) Mar 25, 2009

In my contemporary biology class, we heard about a gene found in males of Northern European descent that has HIV/AIDS resistant properties. My family is very Irish (my last name is Sullivan), and I was wondering not only if this is true, but if there was a way I could get check for it.

Response from Dr. Frascino

Hi,

I believe what you are referring to is the delta 32 gene mutation. See below.

Dr. Bob

Had unprotected sex with a guy who has ccr5 delta 32 (DELTA 32) Oct 13, 2008

Last night I had unprotected sex with a guy who claims that he has ccr5 delta 32 and got a negative HIV test recently. I'm worried about it as his ex is positive. My question is do people who have ccr5 delta32 carry HIV? Is the risk of me getting HIV low? Shall I take pep or go to get a test? Thanks a lot!!

Response from Dr. Frascino

Hello,

Even if a guy strapped a lie detector on his Mr. Happy, I wouldn't believe claims that unsafe sex is not risky, because your partner states he's "delta 32." I'll reprint below some information from the archives pertaining to delta 32.

Your HIV-acquisition risk should be considered the same as that of anyone else who elected to have unprotected sex. PEP would only be recommended if your partner was confirmed to be HIV positive (or strongly suspected of being HIV positive) and if you had a significant exposure. I can't tell from your question what type of "unprotected sex" you had with Delta-Dude, but I doubt PEP would be warranted. Testing, however, at the three-month mark is warranted. I urge you to reconsider your decision to place yourself at risk for STDs, including HIV, by barebacking.

Be safe. Be well.

Dr. Bob

No HIV in 8 years (DELTA 32) Nov 1, 2007

To Whom It May Concern:

Thank you for your time in reading this. I am writing to ask a question. A good friend of mine is a homosexual male. I have personal knowledge that my friend has had receptive anal sex with over 1,500 men over the past 8 years. My friend frequents hot spots in local parks and public restrooms, and finds sexual partners on the internet. According to my friend (and I find this information credible), over 90% of his sexual encounters were unprotected and most of these men have ejaculated into his rectum. Some of the men who have ejaculated in my friends rectum are HIV positive.

Notwithstanding the fact that my friend has had unprotected sex with this many men, a recent HIV test was negative.

Having had unprotected anal sex this many times and with some known HIV-positive men, why hasnt my friend become HIV positive? Is there anyone, perhaps a research institute, who would be interested in a blood sample of my friend for further analysis? It seems like somebody would be collecting this type of data.

Thank you so much in advance for your response,

Concerned with finding a cure as fast as possible

Response from Dr. Frascino

Hello,

Thanks for your post and interest in helping to find a cure as fast as possible.

If your story about your friend is indeed accurate, he is one lucky boy. He's also a boy with significant psychological issues who is courting disaster with his self-destructive and irresponsible behavior. I'm quite amazed he found 1,350 guys (90% of 1,500) willing to have unprotected anal sex with him. Is he a closeted Republican Congressman or clueless rightwing religious zealot perchance? Oh, never mind. Is it possible he could have avoided infection, despite his activities at the hot spots? Yes, it is. Not every HIV exposure leads to HIV infection. Thankfully! Your friend might even have some genetic predisposition against HIV infection. (See below.) The bottom line, however, is that he's putting his bottom at risk with every unprotected poke he gets and sooner or later he's going to lose the STD/HIV sexual Russian roulette game big time. My advice is that you try to convince your good friend he needs help. We don't need his blood, but he definitely needs counseling and a change in behavior ASAP.

Dr. Bob

HIV+ Resistant Sep 12, 2007

Dear Bob,

Six month after he left me, My boyfriend send me a letter to tell me he had been tested positive and had developped aids. We had been together for two and a half years. We had unprotected sex many times, almost daly. He thinks he was infected throughout our relationship. I received loads from him in my mouth as much as in my ass. I got tested when I received his letter and was diagnosed negative. I got tested every year since then and still negative. It has been five years now and I have had other relationship with many partners. Is it possible that I am immune against the virus. That my body is protected against it. Is there a test we can take to see if our immune system can fight the virus on its own. If so where can I take such a test. I live near Montreal in Quebec, Canada. Thanks for your time. Cheers, Eric

Response from Dr. Frascino

Hello Eric,

Are you immune to HIV? No, most likely not. What you are is damn lucky! I urge you not to push your luck by assuming you are immune. That's playing sexual Russian roulette and ultimately you will lose.

I will reprint below some information from the archives concerning the Delta 32 mutation. This is an evolving story. Even with the mutation you would not be immune to all types of HIV.

Stay safe. Stay well.

Dr. Bob

delta 32 Mar 17, 2007

Dr. Bob ...

I think I may have heard everything now! So, I'm on Craigslist just 'poking' around and I see this guy who wants to have sex - but, he only does it bb. Now, here is where it gets wacky! He's HIV Negative and says, "I just got tested in January, but, I just do that so guys will know the right answer. I don't worry about HIV ... I'm delta 32."

What does that mean? I went to a link, that he provided, and it talked about smallpox, and the plague.

What gives? Is this guy a bit crazy or is he really "safe?"

Can you shed some light, my friend?? :)

Thanks!! Oh and P.S., I thought I found Prince Charming ... But, it wasn't him! I'm still looking! You have any cute friends in Orange County?

QS

Response from Dr. Frascino

Hey QS,

So you were poking around Craigslist looking for some poking?

Delta 32 is a bit complex to explain, but I'll give it a shot. First, some background. HIV can only infect certain cells that have specific "receptors" on their surface that allow HIV to enter. HIV attaches to CD4 receptors. However, CD4 alone isn't enough for viral entry. Another protein called CCR5 is also needed. CCR5 is called a co-receptor. Some folks have a mutation in the CCR5 gene called CCR5-delta 32 mutation. This mutation changes the configuration of the CCR5 protein such that HIV cannot bind to it. Genes, of course, are inherited. If you inherit a CCR5-delta 32 gene mutation from both parents, your chances of becoming HIV infected are dramatically reduced. This occurs in about 1-3% of Caucasians. If you inherit one CCR5-delta 32 mutation (from just one parent), it will confer some protection against acquiring HIV and may make HIV disease less severe if you do become infected. Current estimates are that 10-25% of Caucasians may have a single CCR5-delta 32 mutation.

So should Craigslist Delta-32 Boy "not worry" about HIV? Absofrickinlutely NOT! It is downright dangerous to assume you are safe if you have the CCR5-delta 32 mutation. It is not a guarantee of HIV immunity. HIV is much too smart for that. Some strains of HIV use proteins other than CCR5 as co-receptors to enter CD4 cells.

As for the bubonic plague (Black Death) and smallpox link, it appears that the CCR5-delta 32 mutation may have arisen to protect folks in Europe from these illnesses. The mutation affords protection from these ailments and could have arisen via an evolutionary process. (Yes, right-wing religious wing-nuts, evolution does indeed exist!)

So if you happen to hook up with Delta-32 Boy, you might want to give him a science lesson along with his poke.

Finally, hotties in Orange County? Sure, I know some Prince Charmings in that zip code, but unfortunately none are currently single. So I guess you'll just have to continue kissing those toads until your prince arrives.

Good luck.

Dr. Bob

condom failed (HARM REDUCTION STRATEGIES FOR MAGNETIC COUPLES, 2009) May 27, 2009 I am an hiv neg. female, my boyfriend has been hiv pos. for 20 years.and his viral load has always been undetectable.3 nights ago,after sex, we realized the condom had come off and was still inside me,it took some digging, but he got it out.and it was evident that he had come inside me.. afterwards, i started spotting, and started my period the next day. wich has me concerned.i get tested every 4 to 6 months, and had just been tested a week before..i am not going to get all stressed out about it,i know nothing is ever 100% safe,and it can only make things harder. but, the fact that i was bleeding a little has me worried.. how likely is it i've been infected ?, and how long should i wait to get tested again?.this is the first, and hopefuly the last accident we have had.!!

Response from Dr. Frascino

Hi,

Condom failure does place you at some degree of risk for HIV. That your positive boyfriend has an undetectable HIV plasma viral load would significantly decrease the risk of HIV transmission. However, your spotting may increase the HIV-transmission risk. In situations where there has been a significant HIV exposure, post-exposure prophylaxis (PEP) would be warranted if it can be started soon and no later than 72 hours after the exposure. Your exposure was three nights ago; consequently, this is no longer an option for you. But I would encourage you and your boyfriend to review the information about harm-reduction strategies for magnetic couples in the archives of this forum. We have an entire chapter devoted to magnetic couples. I'll reprint below a sample of what can be found there. At this point we would recommend you have an HIV-antibody test at the three- and six-month marks. The six-month test is recommended by the CDC because you had a significant HIV exposure from a partner confirmed to be HIV positive.

Good luck. I agree getting all stressed out won't help!

Dr. Bob

Undetectable Viral Load in Semen MAGNETIC COUPLE SEXUAL RISK 2009) May 26, 2009

A "big G'day" from Australia to you, Doctor Bob!

I am an HIV positive male involved in a relationship with an HIV negative female.

I have been on Atripla (or the Aussie equivalent) for a year now, and for 10 of those months been undetectable.

My girlfriend and I always practice safe sex - I wouldn't put her at risk for anything!

However, during sex last night, the condom broke. We were unaware that it broke and probably had vaginal intercourse for about 15 minutes before realising it had snapped.

I did not ejaculate inside her, but (obviously), can't tell you how much pre-cum would have "leaked" during this 10 minute period.

What are the chances she would have contracted HIV from me?

We are both frantically worried about it and it is putting a strain on our (otherwise wonderful) relationship.

I have read that a recent Swiss study found that a consistent undetectable viral load in the blood correlated with the semen, but I have read other reports that say this might now be the case.

I am hoping that being undetectable and not cumming inside her stacks the odds well and truly in her favour. What would be the chances of her contracting something from this one-off incident?

Thanks if you can shed any light on the matter, and good luck to you and your partner in your own magnetic relationship - opposites attract!!

All the best, Oz Boy. xx

Response from Dr. Frascino

Hello Boy from Oz,

Here's what we know:

1. The HIV plasma viral load usually, but not always, correlates with the HIV viral load in semen (or cervical secretions).

2. Having an undetectable HIV plasma viral load significantly decreases the chances of HIV transmission.

3. Not ejaculating in the love canal significantly decreases the chance of HIV transmission.

4. PEP (post-exposure prophylaxis) taken as soon as possible and no later than 72 hours after an exposure can decrease the chance of HIV transmission. (You can read much more about PEP in the archives.)

To specifically answer your question, the odds are very much in your girlfriend's favor. However, HIV testing is still warranted. I would also recommend you and your gal-pal review the harm-reduction strategies available for magnetic couples (PEP, PrEP, proper condom use, etc.). I'll reprint below some information from the archives. Please note we have an entire chapter devoted to magnetic couples.

Good luck from one magnetic couple to another! Magnetic couples rock!

Dr. Bob

Hiv infection? Magnet couple stress and fear (MAGNETIC COUPLE SEXUAL RISK 2008) Oct 8, 2008

I am negative at the moment and my boyfreind is HIV positive. he is an HIV educator actually.

After I accepted his status, we finally became intimate with each other. I did oral sex on him 3 times that night. Twice on his penis and once with his ass. He precums almost instantly (I don't know if its just with me lol), but I feel like despite the wealth of knowledge about the risk of unprotected oral sex I feel like I may have exposed myself. I didnt not swallow much if any precum. I had a little after taste and I mouthwashed mid session. I only have minor gum bleed after toothbrushing. I am a little concerned about anal oral intercourse too even thought I saw no possible way i could get infected. He penetrated me with a condom and i am not concerned about infection there.

I just want to feel a little assured about my chances for infection here. I love him so much and I find it hard to be intimate with him without thinking about his status. It's a reason why I can't put myself in a condition to penetrate him. And I feel horrible even thinking about talking to him about it because he is an HIV educator and probably know more than most about safe sex practices. Gawd, Just thinking about it and letting my mind run amok about possible infection makes me want to cry becasue I dont want to hurt nor loose him, but I want to trust him with us and our intimacy. And I want to be able to give him my all when we make love without holding myself back.

Given what I said, what were my exposure risks. And what advise do you have for me and the relationship with the one i can see myself with forever?

Response from Dr. Frascino

Hello,

Your HIV-acquisition risk is extremely low. There have been no documented cases of HIV transmission due to rimming or getting rimmed. Oral sex carries only a very slight risk for HIV acquisition/transmission. You can read much more about this in the archives of this forum. We have entire chapters devoted to oral sex and sexual-HIV transmission risk.

Regarding your concerns about sexual activity within a magnetic relationship, as you might imagine, you are not alone. It's something all magnetic couples must come to terms with. Communication is key and that is what is lacking in your current relationship! That your Mr. Right is an HIV educator should make communication easier, not more difficult! Chances are he's as worried about infecting you as you are about acquiring the virus. The two of you are overdue for a heart-to-heart (note that's heart-to-heart, not hard-to-hard) talk! You need to openly discuss your concerns and together the two of you need to develop sexual rituals based on what is known scientifically about the HIV-transmission risk and on your individual levels of comfort. I suggest both you and your Mr. Wonderful read through the chapter in the archives devoted to magnetic couples. You'll soon see your concerns are shared by many of us in serodiscordant relationships. In addition to taking equal responsibility to make sure HIV is not transmitted, there are a number of other measures the two of you might want to consider to further reduce transmission risk:

1. Have your poz-partner take antiretrovirals to drive his HIV plasma viral load down to undetectable levels. This will significantly decrease transmission risk.

2. Get a starter dose of PEP (post-exposure prophylaxis) to have on hand just in case there is an accidental exposure (condom break).

3. Consider PrEP (pre-exposure prophylaxis). This involves the negative partner taking antiretroviral medication prophylactically on a routine basis. We still don't know if this approach is effective. Clinical trials are underway. Some magnetic couples aren't waiting for the results of the trials, but rather are instituting PrEP as a harm-reduction strategy now.

You can read much more about PEP, PrEP and other risk-reduction strategies in the archives.

Finally, I want to assure you from personal experience that opposites attract and that happily-ever-after can indeed become a reality for magnetic couples. Steve (Dr. Steve, the expert in The Body's Tratamientos forum) is HIV negative. I'm "virally enhanced." We've been happily-ever-aftering for 15 years and yes, that includes toe-curling, wake-the-neighbor, own-name-forgetting fusion sex. My advice to you is to make sure Mr. Right doesn't get away for all the wrong reasons.

Good luck to you both!

Dr. Bob



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