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Jun 25, 2006

My partner was recently infected after we agreed to bareback. What are the risks to us having raw sex. Does the risk increase if one of us starts taking meds. Wil he continue to be a long term progressor as I have been. He labs showed a t cell count of 143 and a viral load of 20,000.

Response from Dr. Daar

These are all great questions. Unfortunately, we don't have all of the answers but I will share with you some general thoughts onthe two issues you have raised for your consideration.

Regarding your question related to the risks of HIV-infected individuals continuing to engage in unprotected sexual activities. In general the greatest concerns are the spread of sexually transmitted diseases such as chlamydia, gonorrhea, syphilis, hepatitis B, warts, possibly hepatitis C, and others. Some of these are treatable (e.g. chlamydia), others often are preventable (e.g. hepatitis B with a vaccine) and some are not treatable (e.g. warts which are associated with anal cancer in men) or very difficult to treat (e.g. hepatitis C). There are also concerns that HIV superinfection, or as you refer to it as "reinfection" can occur in this setting. This situation is one where an HIV-infected person becomes infected by a second strain of HIV from another person. Over the last several years there have been several reports that suggest this may occur. Even more importantly, in the situations where this appears to have occurred there is evidence that disease may progress more quickly in the superinfected individual, perhaps because their system has not adequately adapted to control the new virus. It is for these reasons that it is generally recommended that HIV-infected couples consider continued condom use. If one of the couple is on therapy and has developed drug resistant virus it is also possible that these strains could be transmitted to the partner, making it more difficult for them to be treated.

The other part of your question relates to how your partner will do with the virus. You suggest that you have been a long term non progressor and ask whether your partner will be the same since he presumably has the same virus as you. Unfortunately, determinants of the rate of disease progression is dependent upon many factors and not just the virus so it is impossible to determine how he will do with the virus other than to have him followed closely with serial laboratory measurements.

Best, Eric

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