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Serosorting: does it make sense?

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"High risk practices could result in re-infection with one or multiple viruses, which could present resistance mutations and then could compromise antiretroviral treatment (our patient was re-infected with one virus showing AZT and 3TC resistance mutations)," Dr. Lopez-Galindez told Reuters Health

After reading this I started to doubt whether serosorting is worth considering.  Can anyone help me?

Matty the Damned:
I've always understood that re-infection or super-infection is a very rare occurance. I certainly don't concern myself about it.

(Who serosorts whenever possible)

Is this about serosorting, or about reinfection/superinfection? I assume when you mention your concerns, you are talking about unprotected sex with partners of the same serostatus?

If its about serosorting in order to contain HIV infection, then yeah, serosorting makes sense.

Superinfection and reinfection is still a subject of great debate. Currently, there are less than two dozen confirmed cases of reinfection, and even these are disputed as latent viral mutations. Most scientists agree that reinfection, if it is going to happen, will do so in the first months of infection, before the dominant strain of the virus has established itself.

It's about negotiated risk, and what is considered by the individual to be an acceptable risk. Personally, I am very skeptical of the reinfection theory, but even then would likely not have unprotected sex with someone who is newly infected, to be absolutely safe.

Insofar as serosorting goes, I certainly prefer to do so. But then again, you can't always make an intellectual choice insofar as physical and/or emotional intimacy is concerned. Sometimes two people fall in love, and have to deal with the complications.

However, for your own edification, I would hardly stop my scientific inquiry after a single quote from a single researcher in a single article. I would urge you to do the homework yourself, and come to an informed conclusion based on the preponderance of evidence.

Best review of all the science is still HIV Superinfection vs Dual Initial Infection: What Clinicians and Patients Should Know on Medscape, so you need to regsiter (free) or search for the article on Google and view the cached version.

This concludes:

"So what messages about superinfection should HIV clinicians be giving their patients? It is important for patients -- particularly those who are newly infected and have HIV-positive sex partners -- to know that 15 of 16 apparent superinfections described in the scientific literature occurred during the first 3 years of infection. At this time, there is evidence to suggest that patients who have been infected for over 3 years are not at risk for superinfection. However, these patients should also be informed that superinfection could complicate treatment and lead to more rapid disease progression, and it is not known whether exposure to different viral strains during early infection provides protective immunity against later superinfection. Finally, 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."

Overall, the risk of acquiring a second (resistant or non-resistant) HIV infection via sex is unlikely. There have been less than 2 dozen documented cases of transmission of resistance. These case studies make for dramatic papers at conferences, but they are the exception not the rule. Being infected less than 3 years makes it more likely.

Risk factors for acquiring a second HIV infection are the same as first time round. The factors likely to contribute to the degree of risk are:

1. Viral load: higher = more risk

HIV infection where viral load is below 1,500 seems to be uninfectious between heterosexual couples (ie regular partners), regardless of condom use. This result is repeated time and again in large long term studies. Whether this applies to gay men (especially anal sex) and casual partners is a good question. But viral load being low or high is probably important.

2. Sexually transmitted infections

Having a sexually transmitted infection makes infection with HIV more likely.

3. Host factors: characteristics of your immune system, you HIV history.

The closer you HIV infection and treatment history to another person the less the chance of a significant second infection.

If you are on the same treatment as someone, and both have undetectable viral loads and have the same treatment history and resistance profile, then the chance is practically zero.

As you and another person diverge in infection/treatment profile the risk will rise.

- matt

Many advocacy groups claim that serosorting is a prevention tool, and that studies (MSM's in the SF area)  have shown a decline in HIV transmission, yet a dramatic rise in other STD's.  Since the "superinfection" theory is somewhat of a myth, serosorting could be an option for two Poz people in a monogamous relationship.


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