Sexual transmission of drug resistant HIV through pre-cum

Question

I recently recieved back a positive result on my hiv test. My partner of 8 months tested positive 7 months ago. I have not had sex with anyone else since meeting him and for about 3 months prior to meeting him. I tested negative when he received back a positive. So, I am positive I was infected by him. Oh, he has been on the "cocktail" and is "viral load undetectable". I am starting a similar drug regimine soon. My question is, are we now able to continue sex safely without reinfection concerns and can we practice unsafe sex with a low risk of problems?

Answer

Thank you for your question.

The issue of reinfection has been reviewed in a previous posting (HIV POSITIVE COUPLE CONTINUING SEX). In addition to that posting, I would like to review with you some recently published information regarding sexual transmission of drug resistant strains of HIV.

It has now been published that strains of HIV that are resistant to various antiviral drugs, can be sexually transmitted from one person to another. Once a person becomes infected with one of these strains, they can then become resistant to antiviral drugs as well. If your partner does not take his medications exactly as prescribed, or if he has been on medications for prolonged periods of time, he may develop drug resistance. If he then reinfects you through unprotected sex, you can then acquire the drug resistant strain as well. As a result, you yourself may then become resistant to the same drugs. This is especially a problem if both of you are on the same medications, and you continue to have unprotected sex. In other words, if he develops drug resistance and then he reinfects you, you may develop problems with drug resistance as well.

In a recently published case report, a man with HIV was not taking his medications exactly as prescribed. As a result, he developed drug resistance to multiple antiviral drugs (including protease inhibitors). This man then had unprotected anal sex with another man who had previously tested HIV negative. The infected man was the top (insertive) partner and the uninfected man was the bottom (receptive) partner. Ejaculation did not occur during intercourse, so the bottom partner was only exposed to pre-cum (not semen). Soon afterwards, the bottom partner was found to be HIV positive as well. When follow-up studies were done, it was found that the bottom partner was already resistant to the same drugs as the other man. As a result, the man who just became infected was already resistant to multiple antiviral drugs (including protease inhibitors), severely limiting his treatment options in the future.

This case shows that sexual transmission of drug resistance does indeed occur. It also shows that pre-cum alone can lead to transmission of HIV, although the risk is less than exposure to semen.

In summary, if you have unprotected sex with your partner, his drug resistance problems (if they occur) can ultimately become your drug resistance problems.

If you have any further questions, please feel free to call the Centers for Disease Control at 1.800.232.4636 (Nationwide).