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what is safe for 2 poz guys to do
May 27, 2011

Hi Dr Bob

i have asked questions before and really appreciate you and the other Doctor's service. Hoping you can help me with this one.

I recently met a great guy who is also poz. We were both diagnosed about 10 years ago. We are both on meds and both undetectable. I am on Truvada, Ziagen and Viramune. He is on Truvada and Kaletra. We both have good CD4 counts as well.

He seems to feel that we can do anything. Even unprotected anal sex. I remember hearing in the past about super infection and different strains of the virus but don't know if that is the latest prevailing wisdom? We are both not resistent to any medications. Please if you could tell me what is safe for us to do. Unprotected anal, protected anal, rimming, ingesting each other's semen etc.

I appreciate your help so very much. i thought my dream had finally come true to meet someone who was also positive. that i would not feel the shame of having to tell someone and risk being rejected, but it seems there's are still questions none the less even with us both being positive.

thank you again

Matt

Response from Dr. Frascino

Hi, Matt.

Congratulations on meeting your Mr. Happily-Ever-After Positively Charged Mate!

As with any couple the two of you must decide what level of risk you are willing to take between the sheets (or swinging from the chandelier). Yes, superinfection has been documented but we don't know how often this actually occurs. It seems to be more likely to occur early in the course of the infection.

The published guidelines continue to recommend latex condoms for insertive sex for poz-poz couples. There are a number of reasons for this, including preventing HIV superinfection. But in addition condoms offer protection against many other STDs. If one or the other of you has an "extracurricular" activity, there is always the possibility you could bring an unwanted visitor home to your partner. Concurrent STDs or other infections can cause HIV to flare rather dramatically.

Regarding the HIV-transmission risk statistics for the various activities you mentioned, you can read about these in the archives. However, it is worth noting that being on effective combination antiretrovirals that drive HIV plasma viral load to undetectable levels significantly decreases HIV-transmission risk across the board.

Good luck, Matt.

Dr. Bob



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