unprotected sex when both partners are hiv+

[Srb]

I've been wondering about something. If two sexual partners are both hiv+ is there any benefit to practicing safer sex? Can one get re-infected all over again which might negate any progress made from a drug regime? Are people who are on two different drug regimes at risk of introducing their drugs to each other through cum or body fluids which might cause a serious conflict with the drugs they are currently on?

Any enlightenment would be appreciated. These are the type of questions that are difficult to ask the doc.

Thanks.

[jimw]

I just asked my doctor that same question because I recently started dating someone who is positive.  We have made a conscious decision not to use condoms when we have sex.  We are both aware of the debate regarding reinfection and/or super infection, but we personally decided to go forward without using a condom.  We have both been infected for about 4 years, although we were both only recently diagnosed, our VLs are undetectable and our tcells are in the 800s.  My doctor, who is head of HIV research at NYU, said he was aware of the debate, but did not feel we were at risk.  I guess only time will tell.  In the end (pardon the pun) it is a personal decision you and your partner or boyfriend must make after discussing the issue.  Jim

modified to add - these are the types of questions you should be asking your doctor and if you are not comfortable asking him or her these types of questions you might want to consider finding a doctor who you are more comfortable with.

[Srb]

modified to add - these are the types of questions you should be asking your doctor and if you are not comfortable asking him or her these types of questions you might want to consider finding a doctor who you are more comfortable with.

You are right about this, but it's not so much that my doctor isn't willing to discuss these issues (But I don't know - nerver asked) It's more me being very uncomfortable asking.

[englishgirl]

my concern in this situation (not that it's ever arisen for me thus far ) would be less about re/superinfection and more about exposing myself to other bugs, especially the dreaded hep c. additionally if one partner was on meds i think i'd worry about transferring any resistance, but i dont know enough about science to know if it is considered to be a risk.

[mudman8]

I asked my Dr about this as I got a different std a few months ago from playing around.  I haven't had teh clap in 20 years, ugh, how embarrassing now.

He said that with both people being low viral load, and few partners, there's not much reinfection going on. 

He also said it's the people on speed that has a natural immune system suppression and that are having as much sex as possible indescriminately that make teh health services results go sky high with infectious diseases.

It's sort of up to you as to wheather you want to or not. But there are other things out there like Hep B&C and herpese. Ugh! I'd not want to get that one either.

[NewYorkKat]

Use a condom! It's that simple. No one knows for sure about reinfection (which can happen) and you can get something else you don't want and right now, your immune system is putting up a fight. Don't give it something else to fight. Sometimes, if you not sure of something like that, don't put yourself in it.

[newt]

If you are both undetectable and monogamous there is really no risk of reinfection. There just isn;t enough effective virus - matt

[Srb]

If you are both undetectable and monogamous there is really no risk of reinfection. There just isn;t enough effective virus - matt

Is that really true? Does it stand true then that if someone who is undetectable has unprotected sex with a hiv neg partner, then the negative partner cannot contract the virus?

I've heard that there are new and various strains of HIV however. If a partner had one strain and the other partner a different strain, couldn't that be risky?

And, I know, just fagetaboutit and use a condom. Well, my questions are about not using a condom and the resulting possibilities for two hiv+ partners...

[404error]

I have a fairly healthy unprotected sex life with my left hand.  So far it hasn't fallen off.  I guess that's a good thing.

[newt]

CAPS factsheet - What do we know about HIV superinfection? is a good starting point for a simple review of the science.

There's a bunch of stuff we don't know about reinfection between HIV-positive people. But we do know that confirmed cases are a handful, and cases that affect health and treatment are therefore a handful, out of 1 million+ infections in the northern hemisphere, and these seem to happen in the first 3-4 years after infection..

Practically, the big risk is acquiring a resistant variety. This means sex with a person who has (a) a high enough viral load to permit transmission of (b) a resistant strain that may compromise your treatment.  For two people with undetectable viral loads this is so very unlikely.

In terms of playing the field, though, the usual caution about all the other nasties, in particular hepatitis B and C, and erm, oldie but dangerously destructive to your CD4 count, syphilis.

Personally, as far as reinfection goes, I wouldn't feel obliged to condoms with a regular HIV-positive partner but would with trade << how quaint, trade..I'm gonna get nostalgic

Reinfection and transmission to an HIV-negative person when viral load is undetectable are two different scenarios.  Why? You might think of it like this: can you squat in someone's house when they's at home and the door's locked?

In the case of reinfection the body is already occupied by HIV and it will fight any new HIV off its pitch. Plus the effect of drug pressure (if on meds) is against a new infection establishing itself. In the case of an HIV-negative person, no-one's  home, the door's unlocked, so to speak.

- matt

Now playing: the washing machine, on a water-saving economy cycle

[planonstaying]

Having a low viral load  reduces  risk of transmission it doesn't eliminate it.

http://www.projinf.org/fs/reinfection.html

"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."

[carousel]

I'm having very safe sex.  The only real danger could be dropping a post handjob cigarette in the bed.  Unlikely.

I'm here because I like having sex without condoms.  Getting HIV hasn't changed that.  I am more wary of catching other STDs and even then it is mainly hep c that is the fear. 

I am not worried about super infection.  It seems as likely, well even less likely than being hit by a bus.

[vokz]

Many doctors feel that they have to hedge their bets on advice regarding re-infection (lets face it, if they say the risks are low and they think you will be OK – but you then get re-infected - then they feel that they will be the ones who get the blame).

Personally, if it is with a regular partner who I trust to tell me about any risky behaviour (I am far more worried about other infections than I am about re-infection with HIV) and we are both stable on treatment with undetectable viral loads, then I wouldn’t have a problem with loosing the rubbers.

Without fail, casual contacts get the full selfish defensive latex shield treatment.

Ultimately, whatever you decide to do, you have to accept that the responsibility is all yours.

(The mention of ‘trade’ always sends me on a 90s nostalgia trip to throbbing eardrums and Sunday morning whoreship worship at Trade - with a capital ‘T’ - and the high alter of Tony de Vit).

[newt]

"Recently, there has been considerable media attention about a few well documented cases of suspected reinfection with two versions of HIV-1."

Indeed, suspected. 

The guy was on a treatment break and went off for a shag. The original virus was a clade B virus (typical for the US) the rebounding virus was 12% different, but also a clade B virus. The original clade B virus could not be isolated from the plasma during the virologic rebound but both clade B strains could be isolated from circulating peripheral blood cells.

The researchers conclusion: he got a second HIV infection with another clade B strain during the treatment interruption after an episode of anonymous unprotected sex.

An alternative explanation is possible: the treatment interruption allowed an already existing second virus/sub-population gain the upper hand in the cellular war associated with viral rebound.

Case reports are good for conferences, but not very good science.

It's very hard to know whether to call 'reinfection' or 'change in the viral mix' without a very detailed baseline viral analysis, more than a genotype.  So jury's out and thinking. But, but, people of modest sexual temperament experience the same viral surge/immune system crash...then generally it is a call of 'change'...

Practically, the judgement in the end, for me, comes down to regular partner v trade, and viral load. You can maybe know a regular partner's viral load (and other things) with some reliability, but trade...

- matt

[BirdBear718]

Wear a condom.