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Jul 18, 2011

Hey Dr. Bob, We need a straight answer and I know you're the only one who will give it to us.

Here's the scoop. My partner and I are both POZ and we are strictly monogamous. Can we get rid of the latex suit when we screw? We've heard about superinfection but is that real? Any proof it really exists? Any other things to take into consideration? If we were your patient in the privacy of your office and without the other millions of eyeballs reading this post and your response is there ant way you would say it's OK for us to root like wombats in heat? Thanks mate, Zoltan

Response from Dr. Frascino

Hi, Zoltan.

A "straight answer"? Hmm. Will a "gay response" do?

This question comes up frequently. I've addressed these issues in the past, but maybe it's time for a quick refresher course.

It is certainly true that if you and your stud-muffin wombat are both positively charged (HIV positive), you don't have to worry about causing a new HIV infection. However, there are still good reasons to continue using condoms and for continuing to follow safer sex guidelines. These would include:

1. Avoiding other STDs -- syphilis, gonorrhea, herpes, HPV genital warts, chlamydia, lymphogranuloma venereum (LGV), etc. These infections can send your HIV viral load skyrocketing as the immune system tries to fend off yet another invader. Condoms provide excellent protection against many STDs.

2. Superinfection. HIVers can acquire additional strains of HIV. This has been well documented. Superinfection is responsible for recombinant strains of HIV (two or more subtypes of HIV combining together into a new viral recombinant strain). Superinfection is difficult to document, as it requires specialized laboratory testing that is not routinely available. Consequently we don't know how often it occurs. Most likely it's not all that common, but it does happen. It seems to be most likely in HIVers who are recently infected (first several years of infection). It's also worth noting that it's possible to become superinfected with a drug-resistant strain of HIV.

That said, there are special circumstances. For instance, if two virally enhanced HIVers are in a monogamous relationship and we have information about their viral strains, resistance profiles and other potential concurrent transmissible disease (hepatitis C, for instance), and they are on combination antiretroviral therapy, which has suppressed their viral load to undetectable levels, a case could be made for dispensing with the condoms.

Zoltan, you and your wombat, I mean partner, should talk to your HIV specialist about your specific situation before tossing those extra large rough-rider condoms out the bedroom window!

Good luck. Stay well.

Dr. Bob

Blip and cd4 decline
To give up medication for few moths?

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