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Anonymous
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just wanting to know
      #191189 - 05/13/06 01:47 PM

iam hiv poz and i had sex with another hiv poz person, can i get worse??? iam so scared, i have benn hiv poz for 1 year now.please help me if you can

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AIDS2HIV
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Re: just wanting to know new
      #191203 - 05/13/06 04:05 PM

sure can, ya can get reinfected, also possible to cause a strain mutation thats resistance to meds.....im wondering how you can be positive, and not know about/or be practicing safe sex?....use latex condoms & water based lubricants from start to finish, in your all sexual endeavers....Good Luck & God Bless*

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Anonymous
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Re: just wanting to know new
      #191224 - 05/13/06 07:09 PM

Yes there is a chance that you may become infected with a strain resistant to the drugs you are taking. However, unlike our resident Mother, HIV to Aids, I don't see that the gospel says you have to have protected sex with another HIV positive person. Yes, you may have a risk about the different strains, but it's perfectly normal to want to have that skin on skin and at least you are being responsiblie enough to do so with someone else that is HIV+.

Don't beat yourself up as Aids to Hiv would have you do. You haven't done anything that warrants his holier than tho attidute about what happened.

H2A.....Since when did finding God mean you have free rein to give everyone hell. OH yeah forgot.....you see the truth and feel compelled to spill it....no matter that it's only your truth. Go clean your own house before even thinking your qualified to give anyone else advice. Until you realize that the TRUTH that you are only hiding behind this Christ of yours in order not to face YOUR TRUTH AND REAL WORLD then you are no use to any one else. Anyone that treats people the way you do has a lot of work to do on themselves first. You aren't spouting truth. You are just plain mean and nasty and using the excuse that you have found God to do so. Pretty sad and the reason so many reject your type of religion. You may think you have found your peace but it's real clear to those of us sitting on the side lines you have a long way to go.

God, PLEAZE save us from the Rightous.

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AIDS2HIV
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Re: just wanting to know new
      #191231 - 05/13/06 08:54 PM

ok....take anonymous' advice....go out and kill yourself and your partner...have unprotected sex. this anonymous person is obviously someone who had the truth thrown in there face....probably by me. Anonymous, ya wanna see mean and nasty...bring yer ass down here to ohio......you wanna play games, put your ass where your mouth is......otherwise shut up and quit trying to get people to get infected with your fountain of misinformation. I dont see you coming down here to settle your differences like men, when ya hide behind an anonymous tag, however judging by the fact that ya cant even get my name spelled correctly, may have something to do with not being smart enough to spell one of your own. Balls in your court, come on down to Ohio, you wanna shoot your mouth off on these boards, come on over to my place, be a REAL man, show these people how serious you are, I DARE YOU.

P.S....read up on me here, i dont believe in organized religion*

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Re: just wanting to know new
      #191235 - 05/13/06 09:35 PM

HIV Reinfection
From Mark Cichocki,
Your Guide to AIDS / HIV.
FREE Newsletter. Sign Up Now!
Why safer sex is important.
The question is a common one heard in HIV practices and prevention clinics across the country.
"My partner and I are both HIV positive. Do we still need to use condoms?"

The answer is a resounding "yes". For years HIV reinfection or superinfection as it is sometimes called, has been theorized as a consequence of unprotected sexual encounters between two HIV infected people. Simply put, reinfection occurs when a person living with HIV gets infected a second time while having unprotected sex with another HIV infected person. It's been proven to be possible in laboratory studies as well as in animal trials. And for years, proof that it could happen in real-life situations has been hard to come by. But now, compelling evidence has surfaced in human case studies that have confirmed our fears that HIV reinfection can occur and can be very problematic for HIV infected people.

So I get reinfected. How does that affect me?
As you may already know there are several strains of HIV. In addition, when exposed to medications, HIV changes or mutates over time. If a person is reinfected with a strain of HIV that is different from the strains already present or if a mutated HIV type is introduced into the body through unsafe sex, treatment will be much more complex and potentially ineffective. For example, I am being treated for HIV and my medications are working well...my viral load is undetectable. Then I have unprotected sex with another person living with HIV and get reinfected with their strain...one that is resistant to most medications. Over time, that new strain will flourish in my body, rendering my once successful treatment useless. Eventually my viral load skyrockets and my immune system pays the price.

What should I do to prevent reinfection?
Simply put, to prevent reinfection, safer sex should be the rule with each and every sexual encounter. Be honest with your partner. Insist on condoms each time and explain why. While some feel condoms "kill the mood" or "don't feel as good" as sex without condoms, it is possible to have a very fulfilling sex life that includes condoms.

What if I have already had unprotected sex?
With your partner, introduce condoms into your intimacy. While it will feel different it can be very pleasurable. Also, continue to take your medications as prescribed without missing any doses. Share your concerns about reinfection with your physician and make him aware that you have had an unprotected encounter with another positive person. With this information, your doctor can be in tune to therapy failures is they occur and possible reasons for that failure. He or she may even feel a genotype resistance test could be helpful.

We all know safer sex practices are the most important way to prevent transmission of HIV to the uninfected population. But now it is becoming clear that HIV infected people can benefit from safer sex as well.



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Re: just wanting to know new
      #191237 - 05/13/06 09:41 PM

Doctors have warned patients with HIV they could be re-infected with a different strain of the disease if they practise unsafe sex.
It follows the case of a 38-year-old man who was infected with a second strain of the virus - two years after he had been originally diagnosed as HIV positive.

The case was reported in this week's New England Journal of Medicine by doctors in Switzerland.



It just shows how little we understand what's happening with HIV-related immunity

Dr Bernard Hirschel
They said the case highlighted the need for people with the disease not to engage in risky sex.

They also warned that the case could have implications for scientists trying to develop a vaccine to fight the disease.

Similar cases of re-infection have been reported in the United States and in Thailand.

Diagnosed again

The 38-year-old man was first diagnosed with HIV in 1998. He was subsequently enrolled in a Swiss study to examine the effects of treating the virus early.

The man was successfully treated for more than two years and was taken off the drugs after getting an experimental vaccine intended to boost his immune system.

However, in April 2001 a few weeks after he had unprotected sex with men, his virus level jumped.

Doctors discovered that he had been infected with a second strain of the virus.

The man has since resumed taking medication and is responding well.

Dr Bernard Hirschel of the University of Geneva who is involved in the study said the case highlighted doctors' lack of knowledge about HIV.

"It just shows how little we understand what's happening with HIV-related immunity," he said.

"What would have really have helped to clinch this case is if we had found the source," he said.

"But he had a number of anonymous sex partners in Brazil and it was hopeless."

Vaccine fears

In an editorial in the journal, Dr Bruce Walker and Dr Philip Goulder of Massachusetts General Hospital in Boston said the case showed that people with HIV should avoid reinfection.



It would be misleading to translate these into overly simplistic health information for people with HIV regarding condom use with HIV positive partners

Jack Summerside, THT
They warned that contracting a second strain of HIV could make the disease even harder to treat.

"Superinfection may precipitate more rapid progression of the disease," they said.

Until now, doctors had hoped that infection with one strain of HIV would protect the body from other strains, which would make it easier to develop a vaccine.

More than a dozen strains of the virus have been detected around the world.

Dr Walker said that there was concern that even if an effective vaccine is developed it will not protect against all strains of the disease.

Scientists are already working on vaccines for specific geographic areas.

Risks vary

But Jack Summerside, head of Living Well with HIV services at the UK's Terrence Higgins Trust said the issue was complex.

"It adds to the body of work suggesting the possibility that people with HIV can risk subsequent re-infection with different strains of HIV."

But he added: "There appear to be very specific circumstances where this has been demonstrated.

"These include whether or not the individual is taking anti-HIV treatment, and the degree of difference of HIV sub-type between partners.

"It would be misleading to translate these into overly simplistic health information for people with HIV regarding condom use with HIV positive partners."



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Re: just wanting to know new
      #191239 - 05/13/06 09:51 PM

Fears confirmed in study of second-strain HIV 'reinfection'

Washington Blade - September 27, 2002
Kathi Wolfe


--------------------------------------------------------------------------------
Prevention to focus on HIV-positive men who view unprotected sex with positive partners as safe
A recent study and an accompanying editorial published Sept. 5 in the New England Journal of Medicine cast doubt on the widely held assumption among HIV-positive persons that they can't be re-infected with the AIDS virus.

The research findings could have profound implications for prevention and the search for an AIDS vaccine, AIDS experts say.

The "HIV-1-Superinfection" study documents the case of a 38-year-old HIV positive man who became infected with a second strain of the AIDS virus. He acquired the first strain of HIV - primarily found in Southeast Asia - in 1998.

For 28 months, the man had only that strain of the virus and was treated with a four-drug regimen, which ended because of drug toxicity. The man later traveled to Brazil and had unprotected sex, according to the study.

Three months after the treatment ended and three weeks after the unprotected sex, the man was "superinfected" - or re-infected with a second strain of HIV that is "endemic" to Brazil, the study reports.

This is the second documented case of HIV reinfection. The first was confirmed in July 2002 in the Journal of Virology, said Bruce Walker, author of the study and director of Partners AIDS Research Center at Massachusetts General Hospital.

In that instance, an HIV-positive intravenous drug user in Thailand became infected with a second HIV after sharing needles with another drug user. That article didn't get as much attention as the "Superinfection" study, he said.

The "question of superinfection has been around before," Walker said.

"But, the public health implications of this [superinfection] study can't be denied."

In the editorial that accompanied the latest study, Walker took aim at HIV-positive persons who have long assumed that unprotected sex with HIV-positive sex partners carried no AIDS-related risk for eeither.

"Infected and uninfected persons should à exercise the same degree of vigilance to prevent HIV-1 exposure," Walker wrote.

Risks to HIV-positive men

Philippe Chiliade, medical director of the Whitman-Walker Clinic in Washington, outlines a hypothetical situation in which an HIV-positive person is doing well on AIDS drugs and has unprotected sex with his HIV-positive partner.

"He could acquire a new HIV that is resistant to medication," Chiliade said. "He could end up having to be on two different drug regiments: one for his first HIV and another for his second HIV. It would expose him to another set of side effects.

"It could accelerate the progress of his disease," he adds. "It could speed up his demise."

The superinfection study shows clearly that re-infection is a risk, said Frederick Hecht, associate professor of medicine at the University of California in San Francisco.

"But it's still not clear how much risk of superinfection there would be for HIV-positive people who begin treatment at a later period of time [than was the case with the patient in the superinfection study]," Hecht said.

Hecht is still advising most of his patients "not to be excessively alarmed," but said the risk of superinfection "is another reason to be cautious about unprotected sex."

After years of telling HIV-positive men to use condoms, the superinfection study finally confirms that re-infection is a threat, said Matthew Tye, managing director of program services for Gay Men's Health Crisis in New York.

"It adds another layer to the conversation and reinforces what we've done in the past," Tye said. "We'll distribute scientific information and educational materials in sex venues, clubs, the streets and parks."

But, prevention won't be easy, said Scott Brawley, director of public policy of AIDS Action in Washington, D.C. Superinfection and safe sex raise difficult questions about personal sacrifice and free will, he said.

"How much should you be able to chose to place yourself or others at risk versus being responsible?" he asked.

The issue of whether HIV-positive persons should engage in protected sex with one another isn't a simple matter, and older patients are "getting tired of having safe sex," Chiliade said.

"It's easy to say, 'You must have safe sex,' but, it's hard to do all your life," he said. "Who wants to think clearly - to think about condoms during sex? It's such a marvelous moment."

Superinfection could also make it more difficult to develop an AIDS vaccine, researchers say. Vaccines against any virus are usually a "killed" or "weakened, live" form of the virus so that a later exposure to the same virus doesn't take effect because the vaccine has already exposed the patient to it, Chiliade said.

It's possible that vaccinations against AIDS could still leave patients vulnerable to other strains of HIV, he said. But while superinfection may make finding an AIDS vaccine more difficult, "researchers won't give up the effort," Chiliade said.

FOR MORE INFO

New England Journal of Medicine 860 Winter St. Walthan, MA 02451 617-734-9800 www.nejm.com

Gay Men's Health Crisis 119 W. 24th St., 8 Floor New York, NY 10011 212-807-6655 www.gmhc.org

Human Rights Campaign 919 18th St. NW, Suite 800 Washington, DC 20006 202-628-4160 www.hrc.org

AIDS Action 1906 Sunderland Place, NW Washington, DC 20036 202-530-8030 www.aidsaction.org

Whitman-Walker Clinic 1407 S St, NW Washington, DC 20009 202-797-3500 www.www.org



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Re: just wanting to know new
      #191240 - 05/13/06 09:56 PM

Dual HIV Infection

By Nicholas Cheonis

Winter 2005/2006

A number of individuals infected with more than one strain of HIV have been identified over the past few years. Should people already diagnosed with HIV be concerned? Given the limited number of cases seen so far, the risk of multiple infections (also called dual infection) appears to be quite low. And there are many more pressing health concerns facing people living with HIV/AIDS. Nevertheless, two trends are worth noting: dual infection seems more likely to happen under certain conditions, and it is associated with faster progression to AIDS-related events. This article describes current evidence and theories behind this emerging phenomenon.



Coinfection and Reinfection
Researchers make a distinction between two types of dual, or multiple, HIV infection:

Coinfection, or infection with more than one viral strain at or near the same time, is believed to occur around the time of initial infection. (Initial infection is also known as acute or primary infection -- the period before seroconversion that usually lasts from a few weeks to a few months.)

Reinfection with a different strain, also known as superinfection or serial infection, presumably takes place later on during early infection (the first few years of HIV disease, after seroconversion) or chronic (long-term) infection.

In theory, any apparent case of reinfection could be a case of coinfection in which one of the coinfecting strains remains undetectable until it emerges sometime after seroconversion (the point at which HIV antibodies can be detected and a person can be diagnosed as being HIV positive). This is sometimes called sequentially expressed coinfection. Testing limitations that prevent detection of very small viral populations in the body make it difficult to distinguish between coinfection and reinfection. Researchers believe that until a source partner for dual infection is found and the timing of exposure confirmed, it is not possible to determine that the second virus was acquired after seroconversion.

While finding source partners is a continual problem, determining the timing of exposure is aided in some cases by the emergence of acute retroviral syndrome (often flu-like symptoms, including fever and fatigue) in the person presumed to be reinfected. It is not known whether overgrowth of a previously dormant coinfecting strain might also trigger acute retroviral syndrome.





Gathering Evidence
Experts once hoped that a single HIV infection would prevent further infections, much like a vaccination. In the mid-1990s, however, studies using analogous viruses in primates showed that sequential infections were possible. Some people believed it was only a matter of time before something similar would be seen in humans.
Compelling evidence of dual HIV infection in humans appeared in 2002. A report in the Journal of Virology in August of that year strongly suggested reinfection in two injection drug users (IDUs) from Thailand (one female, one male). The woman was initially diagnosed with HIV subtype AE only, followed by detection of subtype B approximately two months later. The man was apparently reinfected with subtype AE virus approximately six to ten months after his primary diagnosis with subtype B virus. Neither individual was being treated for HIV during the study period.

In the September 5, 2002 issue of the New England Journal of Medicine, researchers from the University of Geneva reported on a man initially diagnosed with subtype AE virus in November 1998 whose viral load became undetectable (below 50 copies/mL) with antiretroviral therapy. He stopped treatment in January 2001 and shortly thereafter traveled to Brazil, where he had multiple unprotected sexual contacts. In April 2001, three weeks after his return from South America, his viral load spiked to 400,000 copies/mL and he reported symptoms of acute retroviral syndrome, which can signal a new HIV infection. Lab tests subsequently detected a second strain of HIV -- subtype B, which is common in Brazil. The researchers concluded that reinfection had occurred.

More recently, Davey Smith, MD, of the University of California at San Diego and colleagues reported in the August 12, 2005 issue of AIDS that a man with wild-type (drug-sensitive) subtype B virus was apparently reinfected about a year after his first infection with a different subtype B virus resistant to protease inhibitors, which he had never taken, and 3TC (lamivudine, Epivir), which he started only after the second infection. Another case of dual infection with two subtype B viruses with discordant drug sensitivity was reported by the same research group in 2003. In that case, however, the subject was first diagnosed with drug-resistant subtype B virus and then found to have wild-type HIV of the same subtype four months later. Like the man in the 2005 report, this individual had not taken antiretroviral therapy before the apparent reinfection event.

Other cases of multiple HIV infection have been identified in the past four years, although the total number remains small -- only 16 apparent reinfections by one measure (a 2005 Medscape survey of the scientific literature done by a group from the Gladstone Institute of Virology and Immunology in San Francisco). The Gladstone researchers, however, did not consider cases of coinfection. In addition, dual infection rates may be higher than reported, since few people with HIV have been tested for multiple strains. Only larger future studies using more sophisticated technologies and better tracking of source partners can provide a clearer picture of the incidence (rate of new cases) and prevalence (total number of existing cases) of coinfection and reinfection in a given population.




Impact on Disease Progression
Dual infection in humans has been linked to disturbances in immune control and poorer prognosis. In the case of the man who traveled to Brazil, the emergence of his subtype B virus while off therapy coincided with a loss of 300 CD4 cells/mm3 and a dramatic rebound in viral load before he resumed highly active antiretroviral therapy (HAART) four months later.
In a report from 2004, Smith and colleagues analyzed the two dual infection cases mentioned above plus a third man with apparent secondary infection (wild-type followed by drug-resistant virus). Among the three men, CD4 cell counts dropped an average of 132 cells/mm3 within six months of acquiring the second strain, while viral load levels increased an average of 1.6 logs -- a 40-fold increase.

Geoffrey Gottlieb, MD, of the University of Washington in Seattle and colleagues retrospectively located five individuals with dual infection (four U.S. gay men, one female sex worker from South Africa). Four were coinfected near the time of seroconversion, while the other was reinfected 1.3 years after initial infection. All five had rapid disease progression: from seroconversion to below 200 CD4 cells/mm3 within 3.1 years on average, and to an AIDS diagnosis or death within 3.4 years. Time from seroconversion to AIDS typically takes 8-10 years in untreated individuals.

In a letter to The Lancet in June 2005, Gottlieb proposed that the case of unusually rapid HIV disease progression in a New York City man described by local health officials in February 2005 might also be due to dual infection rather than the emergence of a so-called "supervirus" (see "News Briefs" in this issue).

Several factors might explain an association between dual infection and a surge in HIV disease progression. For now, these are hypothetical and could be related to viral dynamics and the way the second virus attacks the immune system or evades immune responses.

Acquiring a drug-resistant viral strain, for instance, would increase the likelihood of losing a response to antiretroviral therapy. This was seen in Smith's 2005 report as well as others. For those not on treatment, overwhelming a drug-resistant virus (considered less able to replicate) with a new wild-type virus (considered more virulent) could result in a higher viral load and speed progression of disease.

Viral recombination might play a significant role in accelerating HIV disease (see table below). Recombination increases viral diversity more rapidly than mutations that evolve slowly through replication errors. Recombinant viruses may be less sensitive to anti-HIV drugs and are potentially more virulent than nonrecombinant viruses. This might result from altered tropism -- specifically, the virus' ability to use the CXCR4 coreceptor to enter cells, as was the case in the New York man; CXCR4-using viruses are associated with worse disease outcomes than viruses that use the CCR5 coreceptor.




HIV Recombination
Different varieties, or strains, of HIV are grouped in a hierarchy. At the broadest level are the two types of HIV: HIV-1 (most prevalent worldwide) and HIV-2 (rare except in West Africa). HIV-1 is divided into three groups: M (major), N (new), and O (outlier). Group M is by far the most common of the three, and is itself subdivided into different clades or subtypes: A-D, F, G, H, J, and K.

Different subtypes can infect a cell and create hybrid or recombinant forms, such as AC (or A/C). Circulating recombinant forms, or CRFs, are genetically mixed subtypes (such as CRF02_AG) that are found in more than one person.



Most recombination events seen thus far are between different subtypes. But infection with two genetically distinct viruses of the same subtype -- for example, two subtype B viruses -- is also possible. The potential for recombination among these is unknown.

At the same time, science has yet to reveal what might result from viral mixing among different HIV groups or types. But research opportunities might come soon. At the 2005 Retrovirus conference, a French team claimed to have detected the first reinfection of a group O-infected woman with a virus from group M. Almost more remarkably, the research group located the source of her second infection, the gold standard for confirming secondary infection that has eluded other investigators.

While it is generally believed that dual infection must occur for a recombinant virus to be formed, an unusual case of viral recombination in a singly infected woman was reported at the 3rd IAS conference this past July. B. Weiser of the New York State Department of Health and colleagues found that this individual's drug-sensitive HIV evolved differently in her plasma and genital tract after starting HAART and recombined into a multidrug-resistant strain within six months.



Genetically mixed viruses might also be more adept at evading immune responses in a type of evolutionary strategy. At the 3rd International AIDS Society (IAS) conference this past July, Carolyn Williamson, PhD, from the University of Cape Town and colleagues reported finding recombinant virus in six of six dually infected subjects, along with evidence of viral evasion of cellular immune defenses and neutralizing antibodies. The South African team proposed that dual infection "enables recombination to contribute significantly to viral adaptation to immune responses ... and may help explain rapid disease progression."

Alternatively, the link between dual infection and disease progression might be a product of individual characteristics. Gottlieb has speculated about whether certain people who are inherently predisposed to faster disease progression may also be more susceptible to reinfection. His team noted in their 2004 report, for example, that the one subject believed to be reinfected "had rapid CD4 decline immediately after initial infection, suggesting a host susceptibility to infection with a second virus."




Susceptibility and Protection
As to when reinfection might occur, data collected so far show an interesting trend. Researchers at the Gladstone Institute pointed out in their survey of the literature that multiple infections have not been reported in anyone beyond three years after his or her first infection. (Only a female sex worker from Kenya with recombinant AC virus might have been reinfected after three years, but the exact date is unknown due to a nine-year gap in blood sampling.) This observation has been borne out in recent studies in which dual infection was not observed in chronically infected individuals, even among IDUs who consistently shared needles and HIV positive individuals who had partners with different strains and high risk of re-exposure.
While this trend may be an inaccurate observation based on coincidence or testing errors, it has also been seen in primates. A study done in the late 1990s by Ron Otten, PhD, and colleagues from the Centers for Disease Control and Prevention (CDC) showed that macaque monkeys could be infected with two strains of HIV-2 up to four weeks after a first infection, but not between eight and 72 weeks afterwards. Humans might have a similar window of susceptibility to reinfection of approximately three years.

The lack of evidence for dual infection during chronic (long-term) HIV disease suggests a protective mechanism at work, such as immune responses that evolve over time or "viral interference" -- the ability of the original virus to ward off acquisition of another. Any protective role played by anti-HIV therapy in chronic infection would appear to be negligible, since multiple infections have not been reported in untreated chronically infected people after three years.

Dual infection therefore seems to occur only during acute or early infection -- and in these cases, anti-HIV therapy might well make a difference. Evidence suggests that multiple infections happen only in people with acute or early infection who are not being treated or only intermittently treated with anti-HIV drugs. This implies that antiretroviral therapy has a protective effect, at least during early HIV disease, either in blocking secondary infections or in preventing certain coinfecting strains from asserting themselves. Antiretroviral agents used as pre-exposure prophylaxis (PREP), taken before a high-risk incident, might work in a similar way to block a first infection. However, using anti-HIV agents as PREP remains experimental and unproven.

Although continuous antiretroviral therapy (during early disease) and chronic infection (regardless of treatment) each appear to provide protection against dual infection, more research is needed to understand and confirm these observations. Studies are likewise needed to identify any individual characteristics that might make some people more prone to acquiring a second virus. These factors are currently unknown, although cases such as the one described by Gottlieb in 2004 point to the possibility.




Managing Dual Infection
The appearance of genetically distinct viruses within an individual complicates the management of HIV disease. Because multiple infections often lead to signs of accelerated disease progression, the typical clinical response has been to begin or resume anti-HIV treatment. Some people among the recently documented cases have controlled their secondary infection with standard antiretroviral therapy. Others, even if responding well to a first regimen before reinfection, have required salvage or rescue regimens containing four or more drugs. Resistance tests may help guide clinicians in their choice of therapy. Newer drugs and drug classes might likewise improve the chances of treatment success, especially in cases of secondary infection with a drug-resistant virus.
The current understanding of dual infection raises complex questions for people with HIV, clinicians, and prevention workers alike. What approach, if any, should be taken given the small number of cases? Should people with early HIV disease be counseled to start treatment to avoid reinfection, even if their virus is under control? What impact will reinfection have on HIV positive individuals who "serosort," or choose to have sex only with other positive people? Will those with chronic infection feel freer to have unprotected sex despite the risk of acquiring other sexually transmitted infections (STIs)?

As always, the best guide to risk management is reliable information. The Gladstone researchers wisely counsel that "clinicians and researchers should provide balanced and broad views of the risks of unprotected sex between HIV-1 infected persons, and avoid exaggerated or sensational claims about superinfection that could undermine behaviors such as serosorting and serodisclosure that can help to curtail the spread of HIV." Beliefs about multiple infections can affect behavior. In interviews with 193 HIV positive men who have sex with men (33% Latino, 29% African American), researchers from the San Francisco Department of Public Health reported in 2003 that the 83% who believed reinfection was damaging to health were significantly less likely to report unprotected anal sex with an HIV positive partner or any partner compared with those who did not share this belief.




Vaccine Design
Recent dual infection news has been sobering for vaccine researchers, who study the mechanisms the immune system uses to control pathogens (disease-causing organisms) and work to develop agents that will elicit the same immune responses. The specific protective mechanisms, or "correlates of protection," necessary to subdue HIV are unknown, which has been a major obstacle in HIV vaccine research since the beginning of the epidemic. The task is now made more difficult by the knowledge that the immune system cannot reliably prevent reinfection even when responding vigorously to an initial infection.
At the 2003 Retrovirus conference, for example, Todd Allen, PhD, of Massachusetts General Hospital and colleagues reported that a robust and specific immune response to one HIV subtype (B) did not inhibit reinfection with another. The fact that virus-specific immune responses are unable to stop other invading viruses -- even those of the same subtype, as seen in the cases reported by Smith's group -- suggests that priming the immune system with a vaccine to control one viral subtype will not be sufficient, and that designing a vaccine broadly protective against a range of HIV strains might be impossible.

Still, with the added challenge comes a silver lining: the apparent protection afforded by chronic infection, antiretroviral drugs, or individual characteristics. Figuring out how these or other factors allow the immune system to prevent dual infection could be a significant breakthrough and may help guide researchers toward their elusive goal. Given the moribund state of HIV vaccine development, no time should be wasted in exploring this possibility.




Conclusion
What little is known about dual infection has been sketched from a handful of case reports. Uncertainty will prevail until scientists resolve the issue of whether reinfection occurs independently of coinfection. If all dual infections are in fact coinfections acquired at or near the same time, there would theoretically be no risk of later being reinfected with a second strain of HIV. Studies would then focus on why, when, and in whom coinfection takes place, as well as why some coinfecting HIV strains emerge virulently and only during early infection.
If, however, reinfection is a distinct phenomenon, researchers will need to determine precisely what conditions are necessary for multiple infections to occur, who might be more susceptible to them, and what are the clinical implications. Only a fuller understanding of dual infection can help people with HIV make informed decisions about risk. (For information about the Positive Partners study, which looks at whether reinfection occurs between sexual partners, see "Open Clinical Trials.") And, with luck, investigating the dynamics of multiple infections might lead to the ultimate protection: an HIV vaccine.

Nicholas Cheonis is the former editor of BETA.


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Re: just wanting to know new
      #191241 - 05/13/06 09:59 PM

Re-Infection: Is It a Concern for People Living With HIV?

May 2004

Re-infection is a term used to describe a new or secondary infection by a virus that has already infected a person. In most viral diseases, re-infection with the same virus doesn't occur because once the immune system conquers the original viral infection, it creates immunity against that virus. Re-infection occurs almost constantly, however, in some types of infection, such as the cold or flu viruses, because each new version of those new viruses is substantially different from the last. This is why a person may develop immunity to the flu strain that is common in one year, but still be at risk from the strain that becomes dominant the next year.
The question of re-infection with HIV has long been debated. There is no theoretical reason to think re-infection isn't possible, since the immune system never fully conquers the initial HIV infection. Still, many people, including many physicians, clung to the hope that re-infection with HIV either does not happen or that it only happens rarely. This view is the basis of the belief held by some HIV-positive people that having sex or sharing needles with another HIV-infected person poses little or no risks. Many if not most virologists, however, have long believed that re-infection is both possible and perhaps even likely. What is not known are the individual short- and long-term clinical consequences (which may vary from person to person for wholly unknown reasons).

For many years, there were no clear cases of re-infection presented at scientific conferences, but this did not mean such re-infection wasn't occurring. Instead, we know that finding and documenting cases of re-infection is extraordinarily difficult, if for no other reason than that no structured program has looked for them. Finding a case of re-infection has largely been a matter of chance. Yet, several observations over the years support the notion that re-infection is possible, including observations of sex workers in Africa infected with several different recombined "clades" of HIV as well as detailed genetic analysis of a few people's virus suggesting that re-infection was possible. This research is very difficult to conduct. Perhaps the only simple example of re-infection is in western Africa, where people are routinely found who carry both HIV-1 and HIV-2. At the very least, this proves that having HIV-1 does not protect a person from infection with HIV-2.

Recently, there has been considerable media attention about a few well documented cases of suspected re-infection with two versions of HIV-1. The most interesting case, presented by Dr. Bruce Walker, was the result of an almost accidental observation. While researching the effects of Structured Treatment Interruption (STI) in some newly infected volunteers, Walker's team was intrigued by one particular case in which the volunteer responded well to two initial cycles of STI. After each, the person's viral load remained undetectable for several months without treatment. Shortly after a third STI, however, the viral load remained low for only a brief period and then suddenly soared upward. The team wondered what made things different this time? After conducting extensive genetic analysis, they found their answer: the volunteer had become infected with a second, slightly different strain of HIV. Most striking, and discouraging, was that the genetic makeup of the new infection differed by only 12% compared to the original infection. Despite this small difference, the second infection had completely escaped control by the immune system, breaking through the suppression achieved against the original virus. This discovery, while important enough in regards to re-infection, also had discouraging implications for vaccine development, suggesting that as little as 12% variation between viruses might be enough to make a vaccine fail.

Several questions remain in regards to re-infection. Will re-infection lead to more rapid disease progression? Will re-infection with HIV result in transmission/acquisition of drug-resistant HIV that will limit a persons' anti-HIV treatment options? Both of these concerns are theoretically possible, and both have now been demonstrated in case studies. Currently there is not a large amount of data to assess the actual risk to the individual. Although only a little data currently exists and it is extremely difficult to gather more, it does not lessen the real potential for re-infection or its consequences.

There are several reasons why people living with HIV would want to maintain safer sex activities. While the clinical implications of re-infection remain unknown (and will likely be unknown for many years to come), there is some evidence of harm and no evidence of harmlessness. We also know for certain that safer sex does protect against many blood-borne infections that are major causes of life-threatening diseases and death in people with HIV. These likely include CMV, some forms of hepatitis virus, genital herpes, possibly the JC virus (cause of a particularly destructive condition known as Pml), to name a few.

Ultimately people living with HIV need to consider this information and make informed decisions about safer sex for themselves. In the early 1980s many did not want to believe that HIV was caused by unsafe sex. Many people have dearly paid the price for that belief. The optimal outcome here is for people not to fight against data and shy away from acknowledging the potential consequences of re-infection. Some people will come to a conclusion that it's better to be safe than sorry. Others will choose the risk of being sorry rather than safe and will continue to participate in unsafe sex with positive partners. What matters most is that people make a conscious decision based on the available information.



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Our thanks to Project Inform, which provided this article to The Body.


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AIDS2HIV
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Reged: 12/19/05
Posts: 2200
Re: just wanting to know new
      #191242 - 05/13/06 10:02 PM

if that isnt enough info to prove what im saying is possible,just say so....ill post more


to the anonymous who likes to run thier mouth about me, just as Ive proven myself here once again....you bring your sorry ass to ohio, and we'll settle those differences ya have....I'll prove myself on that regard as well*

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ScotCharles
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Reged: 05/06/05
Posts: 924
Loc: Los Angeles
What an idiot! new
      #191269 - 05/14/06 10:13 AM

There are many strains of HIV around, brother, some are more virulent than others and more resistant to the meds. It is irresponsible and stupid to have unprotected sex if you are HIV positive, not to mention illegal in many states and a tort in all states.

Really, if you can't control yourself and protect yourself and others, you are a very sick person indeed, not to mention criminal and tortious.

Don't ever say anything this irresponsible again or I will personally hunt you down and sue you myself for propounding criminal and tortious behaviour.

You are a sick, sick man,



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Anonymous
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Re: What an idiot! new
      #191279 - 05/14/06 10:35 AM

None of this discussion concerns sex with the Negative population.

He's talking about having unprotected sex with another HIV POSTIVE person. Not spreading it to someone that is NEGATIVE.

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Bear60
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Reged: 12/21/05
Posts: 1390
Re: What an idiot! new
      #191281 - 05/14/06 10:36 AM

Charles.... I think you outdid AIDS2HIV.LOL
I have a question: if someone has undectable viral load....does that mean no virus will be found in the semen?

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Survivor
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Reged: 10/30/05
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Loc: Get off the fence and live again!
Re: What an idiot! new
      #191283 - 05/14/06 10:40 AM

bear its still there... tests however cannot pick it up <50 undetectable... but its still there all the same....

GUYS! Quit killing my ADD, I am not about to read this much shit... Can you have a cliffnotes somewhere???

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AIDS2HIV
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Re: What an idiot! new
      #191290 - 05/14/06 11:13 AM

[quote]Charles.... I think you outdid AIDS2HIV.LOL
I have a question: if someone has undectable viral load....does that mean no virus will be found in the semen? [/quote]

Yes virus still can be found, person still can transmit the virus as well.....

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