My question is regarding viral resistance in HIV transmission from a long-time HIVer to a newly infected person. My friend has been in a relationship with an HIV+ partner for 10 years. His partner has been HIV+ for approximately 12 years. Unfortunately, despite 10 years of testing negative my friend was recently diagnosed with HIV. My question is pertaing to viral resistance. Throughout the course of their 10 year relationship my friend's partner has been receiving treatment for HIV. I am not sure specifically as to what kind (though I do know that throughout the course of their relationship he has switched medications several times). Does this mean that my friend has been infected with a very resistant strain that will not respond to the medications his partner has already used? Or will his disease merely progress in him the same (or similarly depending on his body's response)as it has in his partner? Thanks so much for your help.

Hello and thanks for posting. The best answer to your question can be arrived at by your friend having a viral resistance test as part of the initial workup of his infection. This is becoming standard practice - newly infected patients should have a resistance test to determine if they have acquired a drug resistant strain of virus. If this is the case, then this information will help guide drug selection when therapy becomes necessary. The rate of progression depends on many factors and really the only good thing that one can say about drug-resistant virus is that it tends to be weaker than "wild type" virus without resistance.

By the way, it is not a given that your friend will have drug resistant virus. Studies have shown that some patients will have drug resistant virus in their blood, but drug sensitive virus in genital secretions. This phenomenon is related to differences in drug penetration in different compartments of the body. There is a "blood prostate barrier" which prevents certain medications from freely entering the prostate from the circulation which may account for these observations. Best of luck to your friend!