Hello Dr. Daar, I've been HIV+ for about 6 years, and for the past 6 months I've been making the poor choice of having unprotected sex with my positive boyfriend. He always pulls out before ejaculation but I think he does have some precum, although not much. For the past couple of weeks I've been suffering similar symptoms to my original sero-conversion illness and now I'm wondering what to do. I've been off HAART for over 4 years, my last labs, 2 months ago were same as always t-cells 400-500, viral load 15k. My boyfriend is also off drugs, t-cells around 350 and vl also around 15-20k. If I have been reinfected, should I rush to my doctor and get on meds right away? Should I wait and see what my numbers are at my routine check in August? Lastly, I've been tested for everything under the sun in this recent illness. I have no STDs and it's not strep. Now I wish it were...

Thank you for your post.

You are correct that unprotected sex among HIV-infected partners does carry some risk of one partner being infected by the other partner's strain of HIV, so called "superinfection." How often this occurs and what the consequences are of such an occurrence remains incompletely understood, although there is some limited and imperfect data showing that it can be associated with increases in viral load and decline in CD4 cells.

Unfortunately, there are no symptoms that would be suggestive of superinfection and I would not be surprised if what you are experiencing is unrelated. Moreover, there are no clinically useful tests that would allow you to be evaluated for superinfection. My recommendation is to pursue other causes of your symptoms, if they persist, and discuss with your provider and partner the risks of ongoing unprotected sex. I do not believe, based upon what you have written that these new symptoms alone are a reason to start antiretroviral therapy. Consequently, it would be reasonable to continue monitoring and use the numbers and your clinical situation to define when therapy should be started.

Best, Eric