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LTR Sexual Health
Dec 31, 2009

Hi, I'm in a monogamous, long-term relationship with an HIV negative partner. He is the insertive partner and I am the receptive partner. My viral load has been undetectable for five years and I'm 100% compliant with my Atripla regimen. My partner and I have been having unprotected sex for about a year. He understands there is a small risk of contracting HIV from me given my undetectable levels and the lower risk associated with being the top. My doctor is concerned that I may become superinfected with a drug resistant virus. What are the risks of that happening given 1) a monogamous relationship and 2) if my partner did get HIV it would be from me and any drug resistant form that he would get, I would also have.

Thanks, Kyle

Response from Dr. Frascino

Hello Kyle,

I realize that your doctor is appropriately concerned about your health, as you are his patient. However, he should also be counseling you about the risk of HIV transmission to your HIV-negative partner. That is by far the biggest risk related to your decision to bareback as a magnetic couple. It is indeed true that effective combination antiretroviral therapy that drives the HIV plasma viral load to undetectable levels significantly decreases the chance of HIV transmission. However, it does not completely eliminate the risk! Each time you have bareback sex with your Mr. Happily-Ever-After, you are playing a dangerous game of sexual Russian Roulette with his health. Personally, I could never put anyone, let alone the person I love, at such risk.

The risk of dual infection (superinfection or reinfection) is extremely low in your current situation, assuming the monogamous relationship remains monogamous! Dual infections occur most often early in the course of HIV disease. If your partner were to have unsafe sex outside your relationship, in addition to the superinfection risk would be the risk of other STDs as well. Should you contract syphilis, gonorrhea or any other STD, it could cause a spike in your HIV viral load and negatively impact your health and HIV viral control. The bottom line is that you are both at risk from barebacking, although your partner is at much greater risk at the moment. Remember, the vast majority of non-monogamous relationships began as monogamous relationships. A quick read through the archives will graphically illustrate this point! Speaking of the archives, I strongly recommend you and your partner read through the chapter on magnetic couples and hopefully reconsider your sexual Russian Roulette activities.

Be well. Stay well.

Dr. Bob



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