Hey Doc. I have a relatively complex question regarding potential reinfection with a NNRTI resistant mutation. I am HIV chronically infected for well over 5 years. I'm doing well on HAART (Epzicom and Viramune) with undetectable viral load and CD4 counts over 800. I have been abstinent for many years, as to not spread the virus or put myself at risk for additional STIs. I recently, however, met a positive partner and began dating. I am well informed on the data suggesting chronic infection confers some protection against reinfection. In a moment of impulsivity, however, my new date and I had UAI. He informed me that he was on Sustiva and two nukes for three years with complete viriologic suppression and CD4 counts over 1000. However, his doctor recommended a structured treatment interruption approximately 18 months ago. Since then his viral load has climbed very slowly to its current 20,000 level. His CD4 cells remain over 500. The problems lies in that his doctor stopped his regimen at once, disregarding the caution about the extended half-life of Sustiva. He was completely unaware of the risks for developing a NNRTI mutation following such a protocol. My question is, in the chance that he did develop this mutation, am I now at risk for its transimission to me on my current Epzicom/Viramune regimen. This episode represented a single encounter, but it was UAI. I realize this was entirely irresponsbile but self-recrimination will serve no purpose now. My ID follow-up is not for 3 months. Should I take any preventive steps or wait that long to see what happens with my numbers?

You raise several good points regarding the need for caution to avoid reinfection or superinfection as well as about making sure that a thorough discussion occurs between a patient and provider before treatment is stopped.

With regards to your specific situation I would suggest that your risk of reinfection or superinfection from this encounter is relatively low and thus the chance of acquiring a drug resistant virus from this encounter is also quite low. At this time there is little to do other than to take precautions in the future and continue to be monitored. Worse case scenario is your viral load goes up, you do resistance testing and modify your regimen. Most likely scenario is that nothing changes and you continue to do great on your current therapy.

Best, Eric