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possible cross-infection btwn HIV+ couple
Oct 23, 1996

My boyfriend and I are both positive. He for twelve years, me for eight months. He has had pneumonia twice, is a recovering alcoholic and very much into his support groups. We had a "sort-of" relationship years ago, just as friends, but have recently realized we're very much in love and plan to move in together soon. My problem is that when I spend the night at his house, I wake up with a cough. I've attributed this to the AC and the ceiling fan making me too cool after our lovemaking which gets VERY passionate. I this past weekend, I had the same problem, but came down with a 102 degree fever and have been confined to my home for a while. Now I'm worried about something more serious. He is scared that by moving in together, we'll just keep spreading things back and forth between us untill we kill eachother off. He's getting cold feet is all I keep telling myself, since part of the alcoholic psychology is to fail at success. He swears he's not pulling away from me or our commitment, but wants to get answers first. That's why I'm here...to get answers. What should we do to reduce cross-infection when one of us isn't feeling well? Sleep in another room is all I can really think of off hand, but that is so common-sense that he doesn't accept it well as an answer. He wanted to be here with me to take care of me through this bout I'm going through, but I won't let him because of his own concerns. Are either of us overreacting? Is it really as simple as being more aware of our own internal well-being and making minor mutual adjustments to reduce the cross-infection risk? I have lost this man three times before because of his drinking, but have always waited for the right time to come. It's here now, and I can't bear to lose him again. Please, any advice would be greatly appreciated

Response from Mr. Sowadsky

Hi. Thank you for your post. Your concerns are very understandable. When it comes to the risks of getting opportunistic infections from one another, this can be a real risk. There are over 20 diseases associated with AIDS. Each of these can be quite severe, and each is transmitted in different ways. Some are transmitted through airborne contact, for example, Pulmonary Tuberculosis (TB). However, if your boyfriend had active infectious TB, he should be in an isolation room in a hospital. But remember a person with TB isn't always contagious. Other AIDS related diseases can be transmitted by direct contact with various body fluids (like CMV), or through sexual contact (like Herpes infection). By the way Kaposi's Sarcoma, a cancer sometimes seen in AIDS, is now believed to be due to a sexually transmitted virus. Many opportunistic infections are naturally found all around us (Pneumocystis Pneumonia is a good example), and are not usually transmitted person-to-person. Some are acquired by food or water (Cryptosporidium, Isospora, and Microsporidium are examples). Some are transmitted through animals. For example, Toxoplasmosis is transmitted through cat feces (but not the cat itself--just it's feces!!!!!)

The key here is that since AIDS is actually a group of diseases, some can be transmitted person-to-person, and not so for others. The best way to avoid exposing each other to opportunistic diseases is to talk with each of your doctors. If one of you were to get an opportunistic disease, talk to the doctor and ask him/her if that opportunistic disease is transmitted from person-to-person. Some can be, others not. So take this issue on a disease-by-disease basis.

While I'm discussing health risks of 2 positive people together, let me talk about re-infection issues (becoming re-infected with HIV), and STD issues, which are very important to talk about.

Re-infection does indeed pose a risk for several reasons.

If you become infected with another strain of HIV that is drug resistant, you can become resistant to that drug yourself. For example, if you presently have a strain that is sensitive to a protease inhibitor, if you become re-infected with another strain that is resistant to a protease inhibitor, you yourself can become resistant to the protease inhibitor. With only a limited number of antiviral drugs out there, you want to avoid as much as possible acquiring a drug resistant strain.

If you get more of the virus in you, this could potentially increase viral load. The higher the viral load, the poorer the outcome.

If you put yourself at risk of HIV, you're also putting yourself at risk of other Sexually Transmitted Diseases (STD's) which can put a further strain on the immune system. Also, STD's in persons with HIV can be much harder to treat, and the symptoms of STD's can be much more severe in those with HIV.

We're finding that some strains of HIV may be more virulent than other strains. If you get a more virulent strain than the one you already have, this can allow the disease to progress more rapidly.

These are all real risks. This is especially a troublesome situation, especially as it relates to drug resistant strains out there, and the problem with other STD's as mentioned above. Of course, whether you're willing to take those risks is up to you. But in the long run, continuing to have safer sex is in your best clinical interest.

I hope all of this has given you some insight of the situation. The best thing is to talk to your boyfriend about this. And both of you should talk to your physicians, so if you do have an infection that can be transmitted person-to-person, you don't expose the other partner. Let me strongly emphasize that not all opportunistic infections related with AIDS are transmitted person-to-person. There's too many diseases related to AIDS for me to go into detail on each disease. But as the issue arises, talk to your physicians about these diseases to see if any preventative actions need to be taken. If you have questions regarding a particular opportunistic disease, please feel free to contact me directly. If you have any further questions, please feel free to call the Centers for Disease Control at 1.800.232.4636 (Nationwide). Rick Sowadsky MSPH CDS



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