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Author Topic: Re-infection!  (Read 10612 times)

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Offline Nestor

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Re-infection!
« on: June 07, 2010, 07:55:48 PM »

Honestly, the whole time I've had HIV, re-infection or superinfection is something that never even crossed my mind.  That may well have been a mistake.  For one thing, it definitely happens; the articles here http://www.thebody.com/index/treat/superinfection.html cite several cases in which it has clearly happened.  Now it may have happened to me. 

One Sunday afternoon around three weeks ago I became suddenly very ill.  Chills and fever came out of nowhere and lasted for about two days.  Headache and muscle aches lasted a couple of days longer.  Then I was fine again, and then after a few days I suddenly had no energy.  I slept for around twenty hours a day for three days and hardly wanted to eat anything for a week.  One silver lining: I lost twelve pounds! 

In the middle of all this I had my regularly scheduled HIV blood tests.  Two days later my doctor called me and asked me to go in for further blood tests.  The next day she called again and asked me about recent sexual activity.  She said that it looked as if I had been reinfected with HIV! 

Now, I'd only had sex once recently, and it was with condoms.  But a strange thing happened in the middle of that episode.  At a moment when I had my back to the guy, I suddenly thought "Did he just pull out, pull off the condom, and go back in?"  Then I though, "No, that's silly."  After a moment we changed position and I saw him put on a fresh condom.  Now it looks likely that my suspicion was founded on something after all. 

The reason my doctor thinks re-infection is likely is the wildly high Viral Load.  There are also some slight liver abnormalities.  Another thing that has happened is I've recently been infected with cmv.  Apparently a lot of people with cmv don't have any symptoms at all, but some get a flu-like illness which could be why I got sick--or it could be that I went through acute HIV all over again, which has happened with people who got re-infected.  The VL could be explained by cmv: the immune system was so busy fighting cmv that the HIV took the opportunity to go berserk; but 799,000 seems a bit extreme, which is why my doctor is leaning towards superinfection as an explanation. The very low cd4% is explained by dramatic increases in helper cells which may be a result of the cmv as well. 

The possible results of re-infection are:

1. going through acute HIV all over again;
2. possibly acquiring new drug resistances; and
3. possibly getting a more lethal strain of HIV and progressing faster. 

I already seem to have been through one; I'll find out in a week whether two is my case or not, when drug-resistance tests results come back.  But for three only time will tell.

Whether re-infection is what's happened to me or not, please be aware of the possibility!  The whole thing came as such a shock to me because I'd never even thought about it.  I honestly didn't want to write this but I think it is important to warn others of the possibilities.  Thanks for reading, and please, be careful! 
Summer 2004--became HIV+
Dec. 2005--found out

Date          CD4    %       VL
Jan. '06    725    25      9,097
Nov. '06    671    34     52,202
Apr. '07    553    30      24,270
Sept. '07  685    27       4,849
Jan. '08    825    29       4,749
Mar. '08    751    30     16,026
Aug. '08    653    30       3,108
Oct. '08     819    28     10,046
Jan '09      547    31     13,000
May '09     645   25        6,478
Aug. '09    688   30      19,571
Nov. '09     641    27       9,598
Feb. '10     638    27       4,480
May '10      687      9    799,000 (CMV)
July '10      600     21      31,000
Nov '10      682     24     15,000
June '11     563    23     210,000 (blasto)
July  '11      530    22      39,000
Aug '11      677     22      21,000
Sept. '12    747     15      14,000

Offline Rev. Moon

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Re: Re-infection!
« Reply #1 on: June 07, 2010, 09:00:00 PM »
I thought you were on meds?  Must have you confused with someone else.
"I have tried hard--but life is difficult, and I am a very useless person. I can hardly be said to have an independent existence. I was just a screw or a cog in the great machine I called life, and when I dropped out of it I found I was of no use anywhere else."

Offline ds4146

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Re: Re-infection!
« Reply #2 on: June 07, 2010, 09:37:10 PM »
I thought you were on meds?  Must have you confused with someone else.

Might be your Avatar confusing you, or twisting you.

So really!  I think you, Nestor, need to keep us updated.

Offline leatherman

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Re: Re-infection!
« Reply #3 on: June 07, 2010, 10:01:31 PM »
sorry to hear about this Nestor. Could this possibly be just a lab error? Are you having lab work, not just genotyping, done again to verify this? I know I would with such an out-of-the-ordinary change like that.

Here's hoping, if it's not just an error, that at worst it's just #1 and none of #2 or #3
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Oh my friends, my friends forgive me
That I live and you are gone.
There's a grief that can't be spoken.
There's a pain goes on and on.
Empty chairs at empty tables
Where my friends will meet no more.

"Empty Chairs at Empty Tables" from Les Miserables

Offline Rev. Moon

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Re: Re-infection!
« Reply #4 on: June 07, 2010, 10:37:09 PM »
Might be your Avatar confusing you, or twisting you.

If that was an attempt at being bitchy you can go lick the pavement. 

Now, back to the OP, I will have to agree with Mr. Bivins, you may need additional labs to figure out what's going on here.  As far as super-infection is concerned there will be others who are more enlightened on this subject.

I would just caution those who are somewhat newly infected when they read this thread to not become totally paranoid about this subject.  There is a lot more to it than what's being presented here, and there are some who are quite skeptical about the fact that it happens commonly [or at all].  Again, it is a topic that those with more knowledge will hopefully address in a proper manner.
"I have tried hard--but life is difficult, and I am a very useless person. I can hardly be said to have an independent existence. I was just a screw or a cog in the great machine I called life, and when I dropped out of it I found I was of no use anywhere else."

Offline tednlou2

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Re: Re-infection!
« Reply #5 on: June 08, 2010, 12:32:53 AM »
I know the super infection issue is a hot button subject.  I've heard some say it is always a possibility and others say it only happens to people newly infected.  To someone still learning about all this, I think why couldn't you get infected again with a different strain?  It appears to be rare, isn't it?

About the CMV infection-- I thought we really only had to worry about that at lower CD4s.  Your numbers have been high.  Is it uncommon to get OI's with higher numbers?  You're not on meds?  I'm not either and this is something I've asked about--whether not being on meds but with good numbers puts me at higher risk for OI's than HIVers on meds.

 

Offline komnaes

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Re: Re-infection!
« Reply #6 on: June 08, 2010, 02:32:46 AM »
Reinfection and "superinfection", which I assume to mean two different things, are not well researched, so it's kind of surprising to me that your healthcare providers would immediately make that association and informing you so without going through all other possibilities, including as simple and harmless as a lab test fail.

Or have they already ruled out other explanations? For example, have they checked you with other STDs that are very easy to catch but curable, like syphilis? There are many researches concluding that syphilis can cause VL spikes, and all those reinfection symptoms you mentioned could also happen to someone who's going through the primarily or secondary stage of syphilis.

As for CMV, most of us already have it (as much as 85% of the total population by some estimates) but our immune systems mostly keep it in check. But when one's immune defenses are weak, it comes out to attack and kill us like a number of other opportunistic infections (PCP, etc). And like PCP no additional preventive meds are needed unless our CD4 has dropped below 100 or unless one is already suffering from a form of CMV illness like retinitis.

So, the chance is that you are already CMV reactive long before you found out about it recently. But since you said your infection is recent, do you mean that you were tested before and had a confirmed result that you didn't have CMV, but that a recent one shown that you have?

Because as far as I know nobody cares to test for CMV because it rarely causes health problems, not even pozzies like us because the chance is that, like the general population, we already have it, and if we're having a good CD4 number it also rarely causes any troubles. And even if it was a recent infection, primarily CMV also rarely caused any symptoms, and even when they show up they are non-specific and mild... not something that could explain the VL spike. So, in short, don't see how it's relevant to your situation.

Seriously, just trying to be helpful, and I would in particularly recommend you to ask for a full STD panel.
Aug 07 Diagnosed
Oct 07 CD4=446(19%) Feb 08 CD4=421(19%)
Jun 08 CD4=325(22%) Jul 08 CD4=301(18%)
Sep 08 CD4=257/VL=75,000 Oct 08 CD4=347(16%)
Dec 08 CD4=270(16%)
Jan 09 CD4=246(13%)/VL=10,000
Feb 09 CD4=233(15%)/VL=13,000
Started meds Sustiva/Epzicom
May 09 CD4=333(24%)/VL=650
Aug 09 CD4=346(24%)/VL=UD
Nov 09 CD4=437(26%)/VL=UD
Feb 10 CD4=471(31%)/VL=UD
June 10 CD4=517 (28%)/VL=UD
Sept 10 CD4=687 (31%)/VL=UD
Jan 11 CD4=557 (30%)/VL=UD
April 11 CD4=569 (32%)/VL=UD
Switched to Epizcom, Reyataz and Norvir
(Interrupted for 2 months with only Epizcom & Reyataz)
July 11 CD=520 (28%)/VL=UD
Oct 11 CD=771 (31%)/VL=UD(<30)
April 12 CD=609 (28%)/VL=UD(<20)
Aug 12 CD=657 (29%)/VL=UD(<20)
Dec 12 CD=532 (31%)/VL=UD(<20)
May 13 CD=567 (31%)/VL=UD(<20)
Jan 14 CD=521 (21%)/VL=UD(<50)

Online mecch

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Re: Re-infection!
« Reply #7 on: June 08, 2010, 04:45:16 AM »
odd story all around.
hope it works out better soon enough.
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline Nestor

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Re: Re-infection!
« Reply #8 on: June 08, 2010, 05:24:47 AM »
Thanks for the comments!

sorry to hear about this Nestor. Could this possibly be just a lab error? Are you having lab work, not just genotyping, done again to verify this? I know I would with such an out-of-the-ordinary change like that.

Here's hoping, if it's not just an error, that at worst it's just #1 and none of #2 or #3

My doctor did mention the possibility of a lab error, except that a mere error wouldn't just happen to take place at the same moment that I become seriously ill.  One possibility she mentioned is that the presence of cmv or antibodies to cmv may have messed up the HIV VL reading. 

At any rate, I am indeed getting tested again on July 13, and will find out those results on Aug. 2nd--not quite soon enough for my taste but better than waiting 3 months.  There's something about knowing I have a 799,000 VL that's really making me uncomfortable!

 

I would just caution those who are somewhat newly infected when they read this thread to not become totally paranoid about this subject.  There is a lot more to it than what's being presented here, and there are some who are quite skeptical about the fact that it happens commonly [or at all].  Again, it is a topic that those with more knowledge will hopefully address in a proper manner.

I certainly don't advise anyone to be paranoid, but what is the lesson to be drawn from this?  I made a conscious choice only to have protected sex, for my sake and for that of my partners.  And STILL this kind of crazy thing can happen!  So what is the lesson--only have sex with people you know well and trust, who won't randomly pull a condom off in the middle of sex?  Or just live with the possibility that this can happen?  I'm paranoid now!  I think I'm going to be terrified to have sex after this! 

As for reinfection, or superinfection (they do appear to be two names for the same thing) I think everyone who has HIV would do well to read a few of the more recent articles in that page of articles to which I linked in my original post.  It's something we ought to be aware of.  It obviously happens; that has been proven.  How common it is is unclear; one study suggested 4 or 5 percent of people with HIV.  In another study, out of eight people, two were clearly reinfected.  In one case it was a good thing: the guy's original virus had some med resistances, and after reinfection the new strain did not have any!   Still, if I'm understanding correctly, reinfection happens when the new strain of the virus is somehow stronger than the old strain--the new strain conquers and replaces the old strain--and that makes me nervous.  If I've just been reinfected, I"m wondering what this new strain is going to be like to live with. 

Ted, if the illness of the past three weeks is indeed a response to CMV, and not just reinfection, I don't think it is technically an OI.  Here's what Wikipedia says about CMV:

"Most healthy people who are infected by HCMV after birth have no symptoms.[1]  Some of them develop an infectious mononucleosis/glandular fever-like syndrome,[5]  with prolonged fever, and a mild hepatitis."

So most healthy people who get infected with CMV do not get this fever, but some do, and I may have been one of the lucky ones; that might have happened even to someone without HIV.  I think CMV is an OI when people with VERY few t-cells go blind from it or have other serious results: my doctor spent some time today reassuring me that I would have to have around ten t-cells before that kind of thing could happen. 

Komnaes ,  when my doctor saw my lab results--not only the VL but also the liver abnormalities--she immediately had me tested for Epstein-Barr, CMV, and Hep C.  (Presumably the issue of syphillis has not been raised as it would not explain the liver issues?  I'm not sure myself, but surely there must be a reason why my doctor did not mention syphillis as a possibility?  Besides, I certainly didn't see anything like a chancre.) 

These tests were very specific and designed to tell, based on antibodies, whether an infection was recent or old.  With Epstein-Barr, it turned out that I have been exposed to it at some point in the past, but not recently; with CMV it was the opposite: a recent first infection.  I'm not clear whether it is the number or the type of the antibodies that helps determine these things.  CMV could explain both the illness and the liver abnormalities, to the extent that one almost wouldn't need to keep entertaining the re-infection possibility, except for that bizarrely high VL.  Hopefully the next set of labs will put that in some perspective.

Thanks all! 



Summer 2004--became HIV+
Dec. 2005--found out

Date          CD4    %       VL
Jan. '06    725    25      9,097
Nov. '06    671    34     52,202
Apr. '07    553    30      24,270
Sept. '07  685    27       4,849
Jan. '08    825    29       4,749
Mar. '08    751    30     16,026
Aug. '08    653    30       3,108
Oct. '08     819    28     10,046
Jan '09      547    31     13,000
May '09     645   25        6,478
Aug. '09    688   30      19,571
Nov. '09     641    27       9,598
Feb. '10     638    27       4,480
May '10      687      9    799,000 (CMV)
July '10      600     21      31,000
Nov '10      682     24     15,000
June '11     563    23     210,000 (blasto)
July  '11      530    22      39,000
Aug '11      677     22      21,000
Sept. '12    747     15      14,000

Offline edfu

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Re: Re-infection!
« Reply #9 on: June 08, 2010, 05:29:03 AM »
As for CMV, most of us already have it (as much as 85% of the total population by some estimates) but our immune systems mostly keep it in check. But when one's immune defenses are weak, it comes out to attack and kill us like a number of other opportunistic infections (PCP, etc). And like PCP no additional preventive meds are needed unless our CD4 has dropped below 100 or unless one is already suffering from a form of CMV illness like retinitis.

So, the chance is that you are already CMV reactive long before you found out about it recently. But since you said your infection is recent, do you mean that you were tested before and had a confirmed result that you didn't have CMV, but that a recent one shown that you have?

Because as far as I know nobody cares to test for CMV because it rarely causes health problems, not even pozzies like us because the chance is that, like the general population, we already have it, and if we're having a good CD4 number it also rarely causes any troubles. And even if it was a recent infection, primarily CMV also rarely caused any symptoms, and even when they show up they are non-specific and mild... not something that could explain the VL spike. So, in short, don't see how it's relevant to your situation.

Actually, it is estimated that 99% of all gay men are infected with CMV, which is indeed normally controlled by CD4s over 50.  It is exceptionally easy to transmit, usually via......dare I say the word?......saliva.  

"No one will ever be free so long as there are pestilences."--Albert Camus, "The Plague"

"Mankind can never be free until the last brick in the last church falls on the head of the last priest."--Voltaire

Offline komnaes

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Re: Re-infection!
« Reply #10 on: June 08, 2010, 06:25:11 AM »
Quote
Komnaes ,  when my doctor saw my lab results--not only the VL but also the liver abnormalities--she immediately had me tested for Epstein-Barr, CMV, and Hep C.  (Presumably the issue of syphillis has not been raised as it would not explain the liver issues?  I'm not sure myself, but surely there must be a reason why my doctor did not mention syphillis as a possibility?  Besides, I certainly didn't see anything like a chancre.)

Actually, syphilis can attack the liver. Consider that an unsafe sex accident might have happened (and syphilis and other STDs can be transmitted through unprotected oral), I still find it surprising that your care providers did not mention that possibility.

It's up to you my friend.. but my suggestion is still to ask for a STD panel.

PS- modified to add that chancre and other secondary rashes could appear in places that are hard to see, and many people missed them during the critical early period
Aug 07 Diagnosed
Oct 07 CD4=446(19%) Feb 08 CD4=421(19%)
Jun 08 CD4=325(22%) Jul 08 CD4=301(18%)
Sep 08 CD4=257/VL=75,000 Oct 08 CD4=347(16%)
Dec 08 CD4=270(16%)
Jan 09 CD4=246(13%)/VL=10,000
Feb 09 CD4=233(15%)/VL=13,000
Started meds Sustiva/Epzicom
May 09 CD4=333(24%)/VL=650
Aug 09 CD4=346(24%)/VL=UD
Nov 09 CD4=437(26%)/VL=UD
Feb 10 CD4=471(31%)/VL=UD
June 10 CD4=517 (28%)/VL=UD
Sept 10 CD4=687 (31%)/VL=UD
Jan 11 CD4=557 (30%)/VL=UD
April 11 CD4=569 (32%)/VL=UD
Switched to Epizcom, Reyataz and Norvir
(Interrupted for 2 months with only Epizcom & Reyataz)
July 11 CD=520 (28%)/VL=UD
Oct 11 CD=771 (31%)/VL=UD(<30)
April 12 CD=609 (28%)/VL=UD(<20)
Aug 12 CD=657 (29%)/VL=UD(<20)
Dec 12 CD=532 (31%)/VL=UD(<20)
May 13 CD=567 (31%)/VL=UD(<20)
Jan 14 CD=521 (21%)/VL=UD(<50)

Offline Ann

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Re: Re-infection!
« Reply #11 on: June 08, 2010, 06:48:57 AM »

These tests were very specific and designed to tell, based on antibodies, whether an infection was recent or old.  With Epstein-Barr, it turned out that I have been exposed to it at some point in the past, but not recently; with CMV it was the opposite: a recent first infection.


This portion of your post, coupled with Occam's Razor, points to you experiencing a primary CMV infection and not reinfection. And yes, reinfection and superinfection are the same thing.

You had your recent blood tests "in the middle of all this", so why is the high viral load so mysterious? And why couldn't a "mere error" be a coincidental happening? Shit really does happen, you know.


edited because I can really strangle me some syntax when the mood strikes
« Last Edit: June 08, 2010, 06:53:19 AM by Ann »
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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline Hellraiser

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Re: Re-infection!
« Reply #12 on: June 08, 2010, 09:36:59 AM »
This portion of your post, coupled with Occam's Razor, points to you experiencing a primary CMV infection and not reinfection. And yes, reinfection and superinfection are the same thing.

You had your recent blood tests "in the middle of all this", so why is the high viral load so mysterious? And why couldn't a "mere error" be a coincidental happening? Shit really does happen, you know.


edited because I can really strangle me some syntax when the mood strikes

I believe the difference is between reinfection and coinfection (although reinfection can cause coinfection) reinfection is where someone who has been hiv+ for a while supposedly is infected with another strand of the virus whereas coinfection is 2 infections simultaneously either during the first infection or eventually when you are reinfected you are then considered coinfected.

Run on sentences yay.  Superinfection and coinfection are synonymous.

Offline Ann

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Re: Re-infection!
« Reply #13 on: June 08, 2010, 09:48:47 AM »

I believe the difference is between reinfection and coinfection (although reinfection can cause coinfection) reinfection is where someone who has been hiv+ for a while supposedly is infected with another strand of the virus whereas coinfection is 2 infections simultaneously either during the first infection or eventually when you are reinfected you are then considered coinfected.

Run on sentences yay.  Superinfection and coinfection are synonymous.


Crikey. Why don't you just come out and say you don't know? Or just leave it? Your above post is gobbledegook and is only going to confuse people further.

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.
source
« Last Edit: June 08, 2010, 09:50:25 AM by Ann »
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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline leatherman

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Re: Re-infection!
« Reply #14 on: June 08, 2010, 10:03:05 AM »
except that a mere error wouldn't just happen to take place at the same moment that I become seriously ill.
ROFL  :D dude, never take it for granted that 2 (or 3 or 4 or more) weird things couldn't all happen at the same time. A lab error at the time of me being sick would be exactly like the kind of crazy incidents that happen in my life.

Unfortunately without more info, you're just going to have to hang in there ;) and wait to see what all the lab work points to in Aug. (which kinda shows that your doctor isn't as concerned as you are about this anomalous reading)

How are you feeling now? Hopefully better!
And hopefully you'll be feeling better when you have this next batch of new tests done - otherwise you might get another batch of screwy tests back. ::) LOL :D
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Oh my friends, my friends forgive me
That I live and you are gone.
There's a grief that can't be spoken.
There's a pain goes on and on.
Empty chairs at empty tables
Where my friends will meet no more.

"Empty Chairs at Empty Tables" from Les Miserables

Offline Nestor

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Re: Re-infection!
« Reply #15 on: June 08, 2010, 10:20:25 AM »
Komnaes, I would be happy to ask my doctor whether she thinks testing for syphillis would be a good idea.  I guess basically I trust her enough that if she didn't suggest syphllis, she must have had a reason for not suggesting it.  Plus, now with cmv, there's sort of already an explanation for most of what happened, or even all as Ann suggests....


This portion of your post, coupled with Occam's Razor, points to you experiencing a primary CMV infection and not reinfection. And yes, reinfection and superinfection are the same thing.

You had your recent blood tests "in the middle of all this", so why is the high viral load so mysterious? And why couldn't a "mere error" be a coincidental happening? Shit really does happen, you know.


edited because I can really strangle me some syntax when the mood strikes

Funny, I actually thought about Occam's razor this morning when I was thinking about this.  If a primary CMV infection is enough to explain everything, then why the re-infection theory?  And Edfu points out that CMV is easy to transmit, even with saliva.  Re-infection in this case needs to suppose that the guy actually did pull the condom off and that in the few short moments before he put a new one on I got reinfected.  (On the other hand, if 99% of gay men have CMV, and if it's transmitted as easily as that, it's strange that I went to age 36 before finally getting it.)  

But I suppose the high viral load is the center of the mystery here.  Yes, I know that when people get sick their VL goes up, but that much?  Has anyone else here had anything like that kind of rise?  If so, under what circumstances?  From 4,000 to 799,000?  I know that that is what first suggested reinfection to my doctor--the vl looked like the rampant vl of someone who's just sero-converted.  Actually, it would be reallly helpful to know how common this sort of thing is, and why it happens--lab error, illness, etc....

I sure wish it were August 2nd already--I feel like I have spiders running amok inside me.  

One think for CMV--it's the most amazing rapid weight-loss mechanism the world has seen!  I started eating normally two days ago, and I still weigh a pound less today than I did yesterday!  Sorry, it's the one bright spot to cling to in the gloom....
ROFL  :D dude, never take it for granted that 2 (or 3 or 4 or more) weird things couldn't all happen at the same time. A lab error at the time of me being sick would be exactly like the kind of crazy incidents that happen in my life.

Unfortunately without more info, you're just going to have to hang in there ;) and wait to see what all the lab work points to in Aug. (which kinda shows that your doctor isn't as concerned as you are about this anomalous reading)

How are you feeling now? Hopefully better!
And hopefully you'll be feeling better when you have this next batch of new tests done - otherwise you might get another batch of screwy tests back. ::) LOL :D

Leatherman,  I just posted the above when your response came in.  Thanks!  Sure, I guess just being patient is the only thing.  My doctor wanted to test again in one month; I suppose testing again immediately would be useless, because if this is a result of sickness, I'm still sick.  July 13 was the closest available day; I have to wait until August 2nd because I think my doctor will be on vacation in the end of July, but two weeks is usual anyway. 

I'm feeling better, physically, every day, although still have very low energy--I still slept for about twelve hours yesterday.  Emotionally, I'm feeling creepy about this new VL, plus having yet another virus lurking in my system waiting to do who knows what someday. 

Remember the thread in which I said that I always had my labs done in the evening, and now one was being scheduled for the morning, and I was afraid the t-cell count would look abnormally low because of diurnal variation?  That turned out to be the least of my worries!  In fact, the t-cell count is the only thing that came through unscathed! 
« Last Edit: June 08, 2010, 10:27:34 AM by Nestor »
Summer 2004--became HIV+
Dec. 2005--found out

Date          CD4    %       VL
Jan. '06    725    25      9,097
Nov. '06    671    34     52,202
Apr. '07    553    30      24,270
Sept. '07  685    27       4,849
Jan. '08    825    29       4,749
Mar. '08    751    30     16,026
Aug. '08    653    30       3,108
Oct. '08     819    28     10,046
Jan '09      547    31     13,000
May '09     645   25        6,478
Aug. '09    688   30      19,571
Nov. '09     641    27       9,598
Feb. '10     638    27       4,480
May '10      687      9    799,000 (CMV)
July '10      600     21      31,000
Nov '10      682     24     15,000
June '11     563    23     210,000 (blasto)
July  '11      530    22      39,000
Aug '11      677     22      21,000
Sept. '12    747     15      14,000

Offline Ann

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Re: Re-infection!
« Reply #16 on: June 08, 2010, 10:42:08 AM »

Funny, I actually thought about Occam's razor this morning when I was thinking about this. 


Oooo... spooky... you may have been channelling me. Better get checked out for AIDSmeds related dementia, just in case. ;D

Sorry couldn't resist.

It never hurts to get checked out for syphilis. It's spread through skin-to-skin contact and therefore a lot easier to contract - sometimes even when condoms are being used. As the chancres are not painful, they aren't always noticed. And it's not called the great imitator for nothing - it can imitate other illnesses.

While it's unusual for a person of your age to not previously had CMV, it happens. After all, it's not 100% of the population who will test poz - and I'm pretty sure the gay man estimate % edfu gave out is too high. What I've read has been more in the 75% range.

But what I'm trying to say, somebody has to be in the percentage of people who won't test positive for CMV and up until recently, why couldn't that person be you?

It sounds like you were pretty ill with the CMV - it could well have cause a huge blip in your VL. Or it could be lab error. This seems to be how your doctor is thinking - why not just go with it? You're not going to speed your tests along by driving yourself mad and continually fretting about this.

And think of all the CD4s you're going to be drowning in that sea of worry. Stress ain't good for you!
Condoms are a girl's best friend

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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline Matty the Damned

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Re: Re-infection!
« Reply #17 on: June 08, 2010, 03:25:30 PM »
Nestor,

If you're thinking of being tested for syphilis (an excellent idea) be sure your doctor performs a specific treponemal serology like TPHA or FTS-Abs, not just a VDRL or RPR test.

MtD

Offline edfu

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Re: Re-infection!
« Reply #18 on: June 08, 2010, 10:18:13 PM »
While it's unusual for a person of your age to not previously had CMV, it happens. After all, it's not 100% of the population who will test poz - and I'm pretty sure the gay man estimate % edfu gave out is too high. What I've read has been more in the 75% range.

A couple of relevant references:

"The prevalence of CMV infection in homosexual men is quite high (95%) as defined by antibody seropositivity.  Moreover, there is frequent reactivation or reinfection with CMV in homosexual men, as evidenced by the presence of anti-CMV immunoglobulin-M in blood and excretion of the virus."
     --"Enhanced Shedding of CMV in Semen of HIV-Seropositive Homosexual Men," J. of Clin. Microbiol., May 1992

"Antibody to CMV was measured in the sera of 139 homosexual and 72 heterosexual men attending [a venereal disease clinic] and in 103 male volunteer blood donors.  Titers were found in 94% of homosexual patients but in only 54% of heterosexual patients and 43% of male volunteer blood donors."
     --"Prevalence of CMV in Homosexual Men," J. Infect. Dis., Feb. 1981
"No one will ever be free so long as there are pestilences."--Albert Camus, "The Plague"

"Mankind can never be free until the last brick in the last church falls on the head of the last priest."--Voltaire

Offline Matty the Damned

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Re: Re-infection!
« Reply #19 on: June 08, 2010, 11:31:35 PM »
A couple of relevant references:

"The prevalence of CMV infection in homosexual men is quite high (95%) as defined by antibody seropositivity.  Moreover, there is frequent reactivation or reinfection with CMV in homosexual men, as evidenced by the presence of anti-CMV immunoglobulin-M in blood and excretion of the virus."
     --"Enhanced Shedding of CMV in Semen of HIV-Seropositive Homosexual Men," J. of Clin. Microbiol., May 1992

"Antibody to CMV was measured in the sera of 139 homosexual and 72 heterosexual men attending [a venereal disease clinic] and in 103 male volunteer blood donors.  Titers were found in 94% of homosexual patients but in only 54% of heterosexual patients and 43% of male volunteer blood donors."
     --"Prevalence of CMV in Homosexual Men," J. Infect. Dis., Feb. 1981

Nothing more recent?

MtD

Offline edfu

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Re: Re-infection!
« Reply #20 on: June 09, 2010, 01:04:22 AM »
May 2006:

http://hivinsite.ucsf.edu/InSite?page=kb-05-03-03

"CMV is more prevalent in populations at risk for HIV infection; approximately 75% of injection drug users and >90% of homosexual men who are infected with HIV have detectable IgG antibodies to CMV.  Higher prevalence rates among homosexual men correlates with the increased risk of exposure associated with receptive anal intercourse.  In addition, high prevalence rates of CMV IgM antibody in longstanding CMV-seropositive homosexual men suggest that this group is frequently re-exposed to (and at least sometimes reinfected with) differing exogenous strains of CMV."








"No one will ever be free so long as there are pestilences."--Albert Camus, "The Plague"

"Mankind can never be free until the last brick in the last church falls on the head of the last priest."--Voltaire

Offline Matty the Damned

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Re: Re-infection!
« Reply #21 on: June 09, 2010, 01:21:41 AM »
May 2006:

http://hivinsite.ucsf.edu/InSite?page=kb-05-03-03

"CMV is more prevalent in populations at risk for HIV infection; approximately 75% of injection drug users and >90% of homosexual men who are infected with HIV have detectable IgG antibodies to CMV.  Higher prevalence rates among homosexual men correlates with the increased risk of exposure associated with receptive anal intercourse.  In addition, high prevalence rates of CMV IgM antibody in longstanding CMV-seropositive homosexual men suggest that this group is frequently re-exposed to (and at least sometimes reinfected with) differing exogenous strains of CMV."

Cheers babe.

MtD

Offline tednlou2

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Re: Re-infection!
« Reply #22 on: June 09, 2010, 01:45:25 AM »
Nestor,

If you're thinking of being tested for syphilis (an excellent idea) be sure your doctor performs a specific treponemal serology like TPHA or FTS-Abs, not just a VDRL or RPR test.

MtD

Could you explain more about why TPHA and FTS-Abs is better?  I have no idea what test they used on me.  If they did the RPR test and told me I didn't have it, does that mean there is still a possibility I could have it?  I need to read up about these tests more.  I suppose I could have googled this, but you can probably explain better from your own experience.  Aren't there also tests for the Heps, liver, and kidney function that paint a clearer picture than the usual labs that are performed?


Offline Matty the Damned

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Re: Re-infection!
« Reply #23 on: June 09, 2010, 04:50:14 AM »
Could you explain more about why TPHA and FTS-Abs is better?  I have no idea what test they used on me.  If they did the RPR test and told me I didn't have it, does that mean there is still a possibility I could have it?  I need to read up about these tests more.  I suppose I could have googled this, but you can probably explain better from your own experience.  Aren't there also tests for the Heps, liver, and kidney function that paint a clearer picture than the usual labs that are performed?

I don't want to hijack this thread with an indepth discussion of syphilis, a particularly complex disease.

I (and others) have discussed the various aspects syphilis on previous occasions so a search of the forums should provide you with more than enough detail.

I will say that TPHA and FTS-Abs are tests which will can tell if a person has been exposed to Treponema Pallidum the bacteria which causes syphilis. You should think of them as analogous to an HIV antibody test.

VDRL and RPR are non-specific in that conditions other than syphilis can return reactive results on those tests. These tests (most notably RPR) are used to determine the progression of syphilitic disease as well as monitoring the efficacy of treatment. In that sense these tests are analagous to the HIV viral load test.

Effective detection and management of syphilis requires a combination of TPHA or FTS-Abs and VDRL or RPR.

A glossary of terms:

TPHA: Treponema Pallidum Haemagglutination Assay
FTS-Abs: Fluorescent Treponemal Antibody absorbed
VDRL: Veneral Diseases Reference Laboratory test
RPR: Rapid Plasma Reagin test

If you would like to talk about syphilis in more detail, I suggest you open a new thread.

MtD

Offline Boze

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Re: Re-infection!
« Reply #24 on: June 09, 2010, 08:58:26 AM »
I know you have decided against meds for now - but this does sound like one more reason to be on them. I.e. if you were on meds getting another strain of the virus would not be an issue.
==========
Aug08 - Seroconversion
Mar10 - Diagnosis; cd4 690 - VL 19,000
Apr10 - cd4 600
May10 - VL 4,500
Jun10 - started Atripla ; VL 113
Jul 10 - UD vl, CD4 590
Aug 10 - UD, CD4 810, 52%
Nov 10 - UD, CD4 980

Offline Ann

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Re: Re-infection!
« Reply #25 on: June 09, 2010, 09:57:19 AM »
I know you have decided against meds for now - but this does sound like one more reason to be on them. I.e. if you were on meds getting another strain of the virus would not be an issue.

Using condoms - and making sure they remain on the dick that is plugging your hole(s) - also means getting another strain is not an issue. Makes more sense than starting treatment when it isn't necessary.

For someone who has already seen out the first few years of their initial infection, I really don't believe reinfection is an issue anyway.
Condoms are a girl's best friend

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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline Ann

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Re: Re-infection!
« Reply #26 on: June 09, 2010, 10:00:05 AM »
Ed, you're right. I was thinking of the stats that say 75% of poz people are CMV poz.

But even if 95% of gay men are CMV poz, that doesn't mean that Nestor couldn't have been in the 5% who (up until very recently) are CMV negative. Somebody's got to be in that 5% - yes?
Condoms are a girl's best friend

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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline Boze

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Re: Re-infection!
« Reply #27 on: June 09, 2010, 10:02:08 AM »
Using condoms - and making sure they remain on the dick that is plugging your hole(s) - also means getting another strain is not an issue. Makes more sense than starting treatment when it isn't necessary.

For someone who has already seen out the first few years of their initial infection, I really don't believe reinfection is an issue anyway.

How about abstinence? That would also work.

Clearly there are Pros / Cons to the treatment debate. This situation sounds like one in the pro bucket - someone is doing everything by the book and yet is facing the risk of reinfection.

==========
Aug08 - Seroconversion
Mar10 - Diagnosis; cd4 690 - VL 19,000
Apr10 - cd4 600
May10 - VL 4,500
Jun10 - started Atripla ; VL 113
Jul 10 - UD vl, CD4 590
Aug 10 - UD, CD4 810, 52%
Nov 10 - UD, CD4 980

Offline Ann

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Re: Re-infection!
« Reply #28 on: June 09, 2010, 10:14:47 AM »

How about abstinence? That would also work.


But abstinence is no damned fun! :-\
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline Boze

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Re: Re-infection!
« Reply #29 on: June 09, 2010, 10:22:18 AM »
But abstinence is no damned fun! :-\

Same can be said about condoms  ;D

==========
Aug08 - Seroconversion
Mar10 - Diagnosis; cd4 690 - VL 19,000
Apr10 - cd4 600
May10 - VL 4,500
Jun10 - started Atripla ; VL 113
Jul 10 - UD vl, CD4 590
Aug 10 - UD, CD4 810, 52%
Nov 10 - UD, CD4 980

Offline Nestor

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Re: Re-infection!
« Reply #30 on: June 09, 2010, 12:43:47 PM »

Just when I was starting to cheer up a bit--now I'm really depressed.  For a day or two I've had something on the back of my mind, and this morning I got up the courage to check it out.  It's these articles by Dr. Sonnabend:

http://blogs.poz.com/joseph/archives/2010/03/cytomegalovirus_othe.html

http://blogs.poz.com/joseph/archives/2010/04/_hiv_infection_a_dis.html

http://blogs.poz.com/joseph/archives/2010/04/_hiv_infection_a_dis_1.html

They're all about how co-infection with other viruses can speed up HIV progression, and CMV is the star of the show.  A few quotes: 

"Cytomegalovirus (CMV) may be the most important of the herpesviruses that promote HIV disease progression."

"It is not only through their contributions to immune activation that herpes viruses promote HIV replication.   In addition to the pro-inflammatory cytokines that have this effect, herpes virus gene products can directly activate HIV if a cell is infected with both viruses.  This process, called transactivation works both ways; HIV can also activate herpes viruses.

In addition, herpes infections cause a receptor (Fc) to appear on cell surfaces that allows HIV to enter it.  In this way cells that do not possess CD4 molecules can become infected with HIV.   Active CMV infections can also exert a mildly immunosuppressive effect.

Herpesviruses, particularly CMV are singled out because they probably play a significant role in the pathogenesis of HIV disease."

And most chilling of all:

"CMV infections are so common that it is hard to find HIV infected individuals who are free from it so that they can be compared to those who are not.   But as early as 1991 this was done with HIV infected hemophiliac patients, when it was noted that those also infected with CMV had a much more rapid progression of their HIV disease."


To someone who's just been infected with CMV---this is terrifying stuff to read! 

Is there anything one can do?

It looks like I should change the title of this thread to "CMV".  Or "Re-infection and CMV: two excellent reasons not to have sex." 




Summer 2004--became HIV+
Dec. 2005--found out

Date          CD4    %       VL
Jan. '06    725    25      9,097
Nov. '06    671    34     52,202
Apr. '07    553    30      24,270
Sept. '07  685    27       4,849
Jan. '08    825    29       4,749
Mar. '08    751    30     16,026
Aug. '08    653    30       3,108
Oct. '08     819    28     10,046
Jan '09      547    31     13,000
May '09     645   25        6,478
Aug. '09    688   30      19,571
Nov. '09     641    27       9,598
Feb. '10     638    27       4,480
May '10      687      9    799,000 (CMV)
July '10      600     21      31,000
Nov '10      682     24     15,000
June '11     563    23     210,000 (blasto)
July  '11      530    22      39,000
Aug '11      677     22      21,000
Sept. '12    747     15      14,000

Offline Ann

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Re: Re-infection!
« Reply #31 on: June 09, 2010, 01:59:54 PM »
I believe that's talking about active CMV infection. Like the acute illness you experienced, or when it becomes a problem in late-stage, untreated hiv infection.

For example, other herpes viruses like zoster or simplex can be latent, or dormant, in the system. They're considered active when they cause shingles or blisters. I'm thinking this may be the case here too. Worth looking into further.

Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline Grasshopper

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Re: Re-infection!
« Reply #32 on: June 09, 2010, 02:23:16 PM »
CMV is nasty. My (deceased) ex died blind due to it. From the start in 1992,  I too tested positive for CMV, but managed to dodge getting sick from it. From 1998 through 2001, when I had no measurable CD4's and VL hovering in the upper 3millions, I had to go to the Ophthalmologist every 6 weeks for precautionary ocular dilated fundus examination. Thank heavens I was and remained clean.
Nowdays with a more than decent CD4 count, I only go in for an eye checkup every other year.

During my revolving hospital door days, I've met others who were not so lucky regarding CMV, as it can strike anywhere in the body.

You can go on making youself crazy about what may or may not happen, or you can relax and have your eyes periodically checked. If you ever get sick, and the ailment is not immediately known, have your doc's double check the CMV titers. Otherwise there is little you can do, other than start HAART and hope your CD4's rise to a safe level.

Offline Ann

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Re: Re-infection!
« Reply #33 on: June 09, 2010, 02:34:18 PM »
Please remember that with the meds nowdays, we're only seeing death and blindness due to CMV in people who are diagnosed very late in infection, don't have access to meds or won't take them when indicated. For people who have access to meds and start treatment when they need to, CMV is not the horror story it was in the dark pre-HAART days.

Don't let yourself get worked up too much over CMV, Nestor. Remember, the majority of us poz people have it - including me.
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline Matty the Damned

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Re: Re-infection!
« Reply #34 on: June 09, 2010, 04:09:57 PM »
How about abstinence? That would also work.

Clearly there are Pros / Cons to the treatment debate. This situation sounds like one in the pro bucket - someone is doing everything by the book and yet is facing the risk of reinfection.



Since you're a numbers maven:


MtD

Offline Boze

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Re: Re-infection!
« Reply #35 on: June 09, 2010, 05:23:43 PM »
That's funny :)

But to be fair, it's orders of magnitude off. There have been about 100 billion people ever born. So the percentage should be more like 99.999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999% maybe more 9s
==========
Aug08 - Seroconversion
Mar10 - Diagnosis; cd4 690 - VL 19,000
Apr10 - cd4 600
May10 - VL 4,500
Jun10 - started Atripla ; VL 113
Jul 10 - UD vl, CD4 590
Aug 10 - UD, CD4 810, 52%
Nov 10 - UD, CD4 980

Offline Matty the Damned

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Re: Re-infection!
« Reply #36 on: June 09, 2010, 05:39:58 PM »
That's funny :)

But to be fair, it's orders of magnitude off. There have been about 100 billion people ever born. So the percentage should be more like 99.999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999% maybe more 9s

Comic license.

MtD

Offline Boze

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Re: Re-infection!
« Reply #37 on: June 09, 2010, 06:58:37 PM »
Proper slogan would only fit on xxxl-size tshirts too
==========
Aug08 - Seroconversion
Mar10 - Diagnosis; cd4 690 - VL 19,000
Apr10 - cd4 600
May10 - VL 4,500
Jun10 - started Atripla ; VL 113
Jul 10 - UD vl, CD4 590
Aug 10 - UD, CD4 810, 52%
Nov 10 - UD, CD4 980

Offline Nestor

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Re: Re-infection!
« Reply #38 on: June 12, 2010, 12:22:52 PM »
I believe that's talking about active CMV infection. Like the acute illness you experienced, or when it becomes a problem in late-stage, untreated hiv infection.

For example, other herpes viruses like zoster or simplex can be latent, or dormant, in the system. They're considered active when they cause shingles or blisters. I'm thinking this may be the case here too. Worth looking into further.



Well, I just spent a few hours re-reading the three Sonnabend articles.  (By the way, Dr. Sonnabend is just one of the most informative and interesting writers about HIV out there!  But sometimes it's a little difficult for me to follow the argument.)  Anyway, most of the article sounds as if he's simply talking about having CMV, any CMV, in your system, but then he writes: 

"Once acquired, CMV, as with all herpes viruses, remains present for life.  The infected individual will produce antibodies against the virus.  However not all those who are CMV antibody positive are actively infected as measured by detecting CMV virus itself in  blood or  body secretions by culturing it  or by techniques like PCR.  Periodic  reactivation however  does occur. 

Using such techniques it is possible to compare HIV disease progression in people with or without active CMV infections.

As early as 1986 an article published in  AIDS Research which I was then editing suggested a correlation of CMV viremia with a poor prognosis for HIV infected individuals.  Since then several additional studies have suggested the same thing.     

  It is difficult to know what comes first; are active CMV infections accelerating HIV disease or is it the other way around?   It's most certainly both, and I'll address this later."


Later on he emphasizes the importance of using condoms for people with HIV--for the purpose of avoiding re-infection with active CMV, which would accelerate the progression of HIV!

 
Please remember that with the meds nowdays, we're only seeing death and blindness due to CMV in people who are diagnosed very late in infection, don't have access to meds or won't take them when indicated. For people who have access to meds and start treatment when they need to, CMV is not the horror story it was in the dark pre-HAART days.

Don't let yourself get worked up too much over CMV, Nestor. Remember, the majority of us poz people have it - including me.

Thanks a lot for the encouragement.  I've come around to being a bit less gloomy about things.  After all, this only means that I've joined the ranks of the vast majority of HIV+ people who already have CMV.  And if my body has dealt with HIV for close to six years now, it's hard to believe that it won't be able to manage another virus.  And yet, a few things are still making me nervous.  For one thing, this CMV must be pretty powerful stuff!  When I got HIV six years ago I went through some sero-conversion symptoms, but it was nothing like the past month! 

I know you have decided against meds for now - but this does sound like one more reason to be on them. I.e. if you were on meds getting another strain of the virus would not be an issue.

You're absolutely right; if you're making a list of pros and cons of starting HAART, this absolutely belongs on the pro side.  Someone on HAART does not have to worry about re-infection.  For me, however, it does not tip the balance.  When I do start HAART I suspect I will have other things to worry about, and being relieved of worry about re-infection does not appear to me to be a good enough reason to give myself those other worries prematurely.  (On the other hand, if I were planning to have lots of unsafe sex, then that would be a diferent story.) 
Summer 2004--became HIV+
Dec. 2005--found out

Date          CD4    %       VL
Jan. '06    725    25      9,097
Nov. '06    671    34     52,202
Apr. '07    553    30      24,270
Sept. '07  685    27       4,849
Jan. '08    825    29       4,749
Mar. '08    751    30     16,026
Aug. '08    653    30       3,108
Oct. '08     819    28     10,046
Jan '09      547    31     13,000
May '09     645   25        6,478
Aug. '09    688   30      19,571
Nov. '09     641    27       9,598
Feb. '10     638    27       4,480
May '10      687      9    799,000 (CMV)
July '10      600     21      31,000
Nov '10      682     24     15,000
June '11     563    23     210,000 (blasto)
July  '11      530    22      39,000
Aug '11      677     22      21,000
Sept. '12    747     15      14,000

Offline Hellraiser

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Re: Re-infection!
« Reply #39 on: June 12, 2010, 09:30:05 PM »
You're absolutely right; if you're making a list of pros and cons of starting HAART, this absolutely belongs on the pro side.  Someone on HAART does not have to worry about re-infection.  For me, however, it does not tip the balance.  When I do start HAART I suspect I will have other things to worry about, and being relieved of worry about re-infection does not appear to me to be a good enough reason to give myself those other worries prematurely.  (On the other hand, if I were planning to have lots of unsafe sex, then that would be a diferent story.) 

I actually posed this question theoretically in a thread where I was asking about HAART individuals being immune to reinfection because their daily dosing essentially acts as a PrEP dose.  Did you guys find some information confirming this hypothesis?

Online mecch

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Re: Re-infection!
« Reply #40 on: June 12, 2010, 10:05:59 PM »
Well couldn't one in theory be exposed to an HIV strain resistant to one's own HAART, and therefore be reinfected?
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline Nestor

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Re: Re-infection!
« Reply #41 on: June 13, 2010, 01:17:29 AM »
I actually posed this question theoretically in a thread where I was asking about HAART individuals being immune to reinfection because their daily dosing essentially acts as a PrEP dose.  Did you guys find some information confirming this hypothesis?

I remember when you said that.  I did not find information, but I found a lack of it.  Specifically, when I thought that re-infection was what had happened to me, I read all those articles in the page I linked to in my original post.  There are lots of cases of re-infection, but they're all among people not yet on HAART.  Unless I overlooked something (which is possible--I wasn't really reading with this question in mind) I did not see a single mention of someone on HAART getting re-infected.  Theoretically it seems it should be possible.  You're on atripla, you get re-infected with a strain that's resistant to atripla, and suddenly atripla doesn't work for you any more.  But I don't think I noticed a single mention of that sort of thing actually happening, and since that seems to be the definitive collection of articles on the subject, that suggests that it just doesn't happen. 

Well couldn't one in theory be exposed to an HIV strain resistant to one's own HAART, and therefore be reinfected?

It seems to me one could; I wonder why it doesn't happen. 
 
Summer 2004--became HIV+
Dec. 2005--found out

Date          CD4    %       VL
Jan. '06    725    25      9,097
Nov. '06    671    34     52,202
Apr. '07    553    30      24,270
Sept. '07  685    27       4,849
Jan. '08    825    29       4,749
Mar. '08    751    30     16,026
Aug. '08    653    30       3,108
Oct. '08     819    28     10,046
Jan '09      547    31     13,000
May '09     645   25        6,478
Aug. '09    688   30      19,571
Nov. '09     641    27       9,598
Feb. '10     638    27       4,480
May '10      687      9    799,000 (CMV)
July '10      600     21      31,000
Nov '10      682     24     15,000
June '11     563    23     210,000 (blasto)
July  '11      530    22      39,000
Aug '11      677     22      21,000
Sept. '12    747     15      14,000

Offline Boze

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Re: Re-infection!
« Reply #42 on: June 13, 2010, 08:12:05 AM »
Well couldn't one in theory be exposed to an HIV strain resistant to one's own HAART, and therefore be reinfected?

I think it would be next to impossible. For that to happen, the virus would have to develop mutations for each three components of the cocktail a person is taking - since, as far as i know, each drug targets a different part of the replication process.
I understand that there are viruses out there with individual mutations, but not across-the-board ones.

So if you face a mutated virus, you'd be effectively working against it with a dual or monotherapy as PEP. And I think that's sufficient to prevent infection.
==========
Aug08 - Seroconversion
Mar10 - Diagnosis; cd4 690 - VL 19,000
Apr10 - cd4 600
May10 - VL 4,500
Jun10 - started Atripla ; VL 113
Jul 10 - UD vl, CD4 590
Aug 10 - UD, CD4 810, 52%
Nov 10 - UD, CD4 980

Offline Boze

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Re: Re-infection!
« Reply #43 on: June 13, 2010, 08:39:23 AM »
For me, however, it does not tip the balance.  When I do start HAART I suspect I will have other things to worry about, and being relieved of worry about re-infection does not appear to me to be a good enough reason to give myself those other worries prematurely.  (On the other hand, if I were planning to have lots of unsafe sex, then that would be a diferent story.) 

What do you expect to worry about when you start HAART? I've started myself this week actually.

I decided to come up with a short list of reasons to not start. What do you think - which are most important to you?

--Side effects that decrease quality of life today
--Unfelt effects on the body that may manifest themselves years later
--Having to take the pill every day for foreseeable future
--Affordability issues
==========
Aug08 - Seroconversion
Mar10 - Diagnosis; cd4 690 - VL 19,000
Apr10 - cd4 600
May10 - VL 4,500
Jun10 - started Atripla ; VL 113
Jul 10 - UD vl, CD4 590
Aug 10 - UD, CD4 810, 52%
Nov 10 - UD, CD4 980

Offline veritas

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Re: Re-infection!
« Reply #44 on: June 13, 2010, 11:07:29 AM »

bozel,

You said: "I think it would be next to impossible. For that to happen, the virus would have to develop mutations for each three components of the cocktail a person is taking - since, as far as i know, each drug targets a different part of the replication process."

It's very possible ! There are plenty of people in these forums whose virus' have mutations against all components of the cocktail ( by the way, there are at least 5 components to various medications ie: RT,NNrt, PI, integrase,ccr5 inhibitors). These resistent strains can be transmitted from one poz to another. If anyone is willing to role the dice and take that chance, the consequences could literally be deadly. Let's not kid ourselves.
http://aids.about.com/od/treatmentquestions/f/resistinfect.htm

v

Offline Hellraiser

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Re: Re-infection!
« Reply #45 on: June 13, 2010, 11:08:56 AM »
bozel,

You said: "I think it would be next to impossible. For that to happen, the virus would have to develop mutations for each three components of the cocktail a person is taking - since, as far as i know, each drug targets a different part of the replication process."

It's very possible ! There are plenty of people in these forums whose virus' have mutations against all components of the cocktail ( by the way, there are at least 5 components to various medications ie: RT,NNrt, PI, integrase,ccr5 inhibitors). These resistent strains can be transmitted from one poz to another. If anyone is willing to role the dice and take that chance, the consequences could literally be deadly. Let's not kid ourselves.
http://aids.about.com/od/treatmentquestions/f/resistinfect.htm

v

This is of course if you think reinfection can happen.

Offline Hellraiser

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Re: Re-infection!
« Reply #46 on: June 13, 2010, 11:12:57 AM »
bozel,

You said: "I think it would be next to impossible. For that to happen, the virus would have to develop mutations for each three components of the cocktail a person is taking - since, as far as i know, each drug targets a different part of the replication process."

It's very possible ! There are plenty of people in these forums whose virus' have mutations against all components of the cocktail ( by the way, there are at least 5 components to various medications ie: RT,NNrt, PI, integrase,ccr5 inhibitors). These resistent strains can be transmitted from one poz to another. If anyone is willing to role the dice and take that chance, the consequences could literally be deadly. Let's not kid ourselves.
http://aids.about.com/od/treatmentquestions/f/resistinfect.htm

v

How cute my first accidental double post, can some mod delete this second please?  Thanks if you can, np if you can't

Offline veritas

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Re: Re-infection!
« Reply #47 on: June 13, 2010, 11:14:14 AM »
This is of course if you think reinfection can happen.

What makes you think it hasn't happened?

"
Hi, Is there any evidence that HIV-reinfection does occur? I have been repeatedly asked if 2 HIV positive individuals have unprotected sex, is there any risk of them acquiring each others strains/resistance patterns? Thanks, Cyrus Badshah, MD

On Aug 13, 2002 Joel E. Gallant, M.D., M.P.H. replied:

--------------------------------------------------------------------------------
Absolutely. In fact, the most convincing case was presented by Bruce Walker at the Barcelona last month. He reported on a patient who was diagnosed and treated within weeks of infection. The patient then went through some STI cycles, leaving him with strong HIV-specific CTL and CD4 responses. Despite this excellent HIV-specific immunity, he developed a flu-like illness shortly after a high-risk sexual exposure. His viral load went up and he had a decline in his HIV-specific CD4 response. The rebounding virus was analyzed and was found to be different from his original isolate, with only 88% homology by phylogenetic analysis, clearly indicating reinfection. If there was any doubt as to whether this can happen, I think this case put it to rest. It also led to considerable consternation, given the troubling implications it has for vaccine development."

v
 


Offline Boze

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Re: Re-infection!
« Reply #48 on: June 13, 2010, 11:21:16 AM »
bozel,

You said: "I think it would be next to impossible. For that to happen, the virus would have to develop mutations for each three components of the cocktail a person is taking - since, as far as i know, each drug targets a different part of the replication process."

It's very possible ! There are plenty of people in these forums whose virus' have mutations against all components of the cocktail ( by the way, there are at least 5 components to various medications ie: RT,NNrt, PI, integrase,ccr5 inhibitors). These resistent strains can be transmitted from one poz to another. If anyone is willing to role the dice and take that chance, the consequences could literally be deadly. Let's not kid ourselves.
http://aids.about.com/od/treatmentquestions/f/resistinfect.htm

v

Thank you for the clarification - so such virus strains are out there. What are these people doing as treatment if they have something like that?
==========
Aug08 - Seroconversion
Mar10 - Diagnosis; cd4 690 - VL 19,000
Apr10 - cd4 600
May10 - VL 4,500
Jun10 - started Atripla ; VL 113
Jul 10 - UD vl, CD4 590
Aug 10 - UD, CD4 810, 52%
Nov 10 - UD, CD4 980

Offline Hellraiser

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Re: Re-infection!
« Reply #49 on: June 13, 2010, 11:25:27 AM »
Sorry I should've been more specific.  If you believe reinfection occurs outside of an acute infection stage.  It's difficult to pin down who is reinfected and I'm a little confused on how it is that they test for reinfection considering the test for HIV isn't for the virus itself but for the antibodies to it.

Offline veritas

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Re: Re-infection!
« Reply #50 on: June 13, 2010, 11:36:16 AM »

bozel,

You asked: "What are these people doing as treatment if they have something like that?"

They wait for new medications to come out. A scary scenario, to say the least.

Hellraiser,

You asked:"  It's difficult to pin down who is reinfected and I'm a little confused on how it is that they test for reinfection considering the test for HIV isn't for the virus itself but for the antibodies to it."

See Dr. Gallant's answer above. They use different tests to determine the strain variety, if there is reason to believe that someone has been re-infected.

v

Offline leatherman

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Re: Re-infection!
« Reply #51 on: June 13, 2010, 01:10:33 PM »
the most convincing case was presented by Bruce Walker at the Barcelona last month. He reported on a patient who was diagnosed and treated within weeks of infection.
is there any other data besides this case? ??? :)

I found more information about this case here: http://www.nypress.com/article-6207-the-bareback-lie.html
According to Garrett, Walker told the scientists in Barcelona that he’d treated a gay Boston man with anti-HIV drugs immediately after infection for several weeks, as he’d done with more than a dozen other patients. The man seemed to do very well, beating back HIV. But after a month, he was surging with virus, which turned out to be a different strain of HIV–a strain that was, genetically, 12 percent different from the strain with which he’d originally been infected. His "immune system was helpless in the face of the apparently new HIV," Garrett reported. The man told Walker that he’d engaged in unprotected sex with another man within 30 days of his original infection.

What this, tragically, means for a vaccine is that even a strain of HIV close to one that you might be vaccinated against can still cripple your immune system, rendering the vaccination useless. (And there are at least seven classes of HIV, each including many strains.) Cornell University AIDS vaccine researcher John Moore told Garrett: "This case, albeit anecdotal, has shattering implications for the development of a prophylactic vaccine." And what it means for HIV-positive gay men who have unprotected sex with one another is that they can be infected with other, perhaps more powerful strains of HIV, and, chillingly, may be passing on drug-resistant strains, helping to promulgate a super-HIV.

"While it’s true Walker’s patient is ‘only one case,’" Garrett tells me, "it would be disingenuous to suggest there is no other evidence of superinfection, or immune system failure, to recognize secondary HIV infection. In fact, [at the conference] three other superinfection cases were described, and by my count at least 10 others have been cited in recent years. What made Walker’s case stand out is the extraordinary caliber of his work on the case. Nobody has previously tracked so many aspects of the virology and immunology of a case, almost from the moment of infection."


to be honest, that isn't really overwhelming evidence. One man, continuing to engage in unprotected sex, who was probably "re-infected" within the first month of treatment and before reaching UD? I would be more impressed by data showing that someone who had been UD for several years was re-infected, not someone who had barely even started treatment.

Plus they speak of "10 other cases". That's hardly a blip in the total HIV+ community (a point zero, zero, zero something chance) - and of course there's no information given concerning the viral load, etc in those 10 cases. If all of those were people within the first month or so of treatment, who had not yet reached and sustained UD, then it might show reinfection as an issue - but an issue for the untreated and those who have not yet had viral suppression.

I would have been more willing to believe this if that article had instead said:
And what it means for HIV-positive gay men, untreated or recently started on HAART, who have unprotected sex with one another is that they can be infected with other, perhaps more powerful strains of HIV, since their strain of infection has not suppressed, and, chillingly, may be passing on drug-resistant strains, helping to promulgate a super-HIV amongst untreated gay men or those only recently starting HAART.

As others have pointed out, it seems reaching UD and staying adherent would act as Prep and stave off any re-infection possibility. Otherwises wouldn't we be seeing reports (even from people in these forums who bareback with other pozzies) becoming reinfected 10 yrs + after their diagnosis?
« Last Edit: June 13, 2010, 01:29:41 PM by leatherman »
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Oh my friends, my friends forgive me
That I live and you are gone.
There's a grief that can't be spoken.
There's a pain goes on and on.
Empty chairs at empty tables
Where my friends will meet no more.

"Empty Chairs at Empty Tables" from Les Miserables

Offline veritas

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Re: Re-infection!
« Reply #52 on: June 13, 2010, 01:53:17 PM »
mikie,

If you read Dr. Gallant's response closely, he states that the patient was diagnosed and treated within the first weeks of his infection--- true. However, he got diagnosed with a different strain one month later after starting ART for his first infection to which he was responding. Now, your link states that there were three other superinfections explained at that same conference and that they had first hand knowledge of at least 10. Those are the one's they know about. Your link also states that the amt of work necessary to determine re-infection( from almost the moment of infection) is what stood out in this case. As the disease progresses, a rise in viral load is usually looked at as poor adherence. Other factors wouldn't be warranted other than a new geno and pheno. The fact remains it did and can happen. So the question remains: "Do you feel lucky?" (Clint's cool). Wheather it's one, ten or 100 your still rolling the dice. Is it worth the potential to ruin one's HAART combination for the sake of a condom?
There are plenty of fun things to do in the bedroom that are safe. Why take the chance?

I wouldn't.

Here's another case:

http://archives.cnn.com/2000/HEALTH/AIDS/02/02/aids.superinfection/


NAPWA chimes in:

http://www.napwa.org.au/resource/hiv-tests-and-treatments/antiviral-treatments/reinfection-superinfection-with-hiv







v
« Last Edit: June 13, 2010, 02:04:09 PM by veritas »

Offline leatherman

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Re: Re-infection!
« Reply #53 on: June 13, 2010, 05:40:42 PM »
unfortunately the information you provided (and thank you for it! :-*) still doesn't seem to provide me the information that I was looking for. I'm not doubting that reinfection is possible, what I'm questioning is exactly WHO is at risk for this phenomon.

For example in the Ottawa case both patients were being treated through a hospital. I am inferring from that, that they were not being successfully treated (as in UD) for 5-10 yrs else why would both patients be in the hospital? Obviously they were either newly diagnosed (perhaps with OIs) or in bad enough health to be hospitalized. It sounds like there were other health factors to consider in why that "reinfection" occurred.

(I would also like to say with this and the previous case I discussed - Damn! Can't these people keep it in their pants long enough to get treated first?!? In the previous case, the guy was already barebacking in the first couple weeks of meds and these guys were in a hospital being treated for their unknown ailments and were busy barebacking. Shoot! I was too sick when I was in the hospital with PCP to think about any kind of sex. Obviously these guys getting diagnosed with HIV didn't teach them a thing about safer sex if they couldn't even wait a couple weeks to not get laid.)

Your other link clearly talks about people being treated for less than 3 years, or people that were non-adherent. That article even goes so far as to state my postulation: "We do know that adherence to treatments may impact and provide protection against the possibility of re-infection occurring (e.g. it may be less likely to occur if both HIV positive partners are currently on treatments with a low or undetectable viral load)."

So as I mentioned previously, all of these cases of "reinfection" seem to be occurring to the newly diagnosed and untreated, the people recently started on treatment who have not yet obtained UD for an extended amt of time, or people with adherence issues (which could have resistance issues or no longer be UD). None of these cases seem to be of people who have remained adherent and been UD for a period of time.

Why take the chance?
because so far the data doesn't point to this being an issue that I will have to face. it seems, so far, that the only ones at risk of a chance of reinfection are mostly "newbies", who haven't started treatment or in whom the virus has not yet been controlled.

Plus there's still that nagging problem - if Prep works then why wouldn't my being on meds for a decade be the best Prep ever?
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Oh my friends, my friends forgive me
That I live and you are gone.
There's a grief that can't be spoken.
There's a pain goes on and on.
Empty chairs at empty tables
Where my friends will meet no more.

"Empty Chairs at Empty Tables" from Les Miserables

Offline veritas

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Re: Re-infection!
« Reply #54 on: June 13, 2010, 06:15:57 PM »

mikie,

Your question:" I'm not doubting that reinfection is possible, what I'm questioning is exactly WHO is at risk for this phenomon."

If you believe (and I know you do) that HAART medications will at sometimes not work depending on the type and amt of mutations you have, then you must also conclude that you could obtain a virus with mutations that would render your medications useless. That being said, theoretically, anyone who barebacks runs the risk . Also, I know you realise that seman still carries a viral load even if the blood is ud.
Prep doesn't work everytime. Here's a good Q&A on Prep from the cdc:

http://www.cdc.gov/hiv/prep/resources/qa/index.htm

I believe what they are trying to do is slow the rate of infection. The only way to stop this pandemic is a vaccine or cure.

As far as the data is concerned, they don't have enough data to prove uneqivically one way or the other.

However, it has happened and I'm not willing to take the chance.

v

Offline leatherman

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Re: Re-infection!
« Reply #55 on: June 13, 2010, 06:54:53 PM »
you could obtain a virus with mutations that would render your medications useless.
Ah! Now there's a reason I can understand. ;)  ;D

Would you have any conjectures then as to why we're not seeing this reinfection phenomon happening throughout the population of HIV+ people who have been in successful treatment for say 5 to 10 years or more? ???

My conjectures: not enough of them are having sex; not enough of them are sero-sorting; not enough of them are having unprotected sex; not enough are actually being exposed to mutated strains; and not enough have enough viral load in their semen.
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Oh my friends, my friends forgive me
That I live and you are gone.
There's a grief that can't be spoken.
There's a pain goes on and on.
Empty chairs at empty tables
Where my friends will meet no more.

"Empty Chairs at Empty Tables" from Les Miserables

Offline Nestor

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Re: Re-infection!
« Reply #56 on: June 13, 2010, 07:27:50 PM »
I'm wondering what a statistician would say was the likelihood of it's happening.  You would need someone on, say, atripla, to have unprotected sex with someone who was completely resistant to atripla, and the first person would have to get re-infected.  What is the likelihood?  

Edited to add: This article http://www.aidsmap.com/en/news/29AD410B-DD10-43B7-A8AE-D86B1EE79E63.asp seems particularly interesting, although I will leave it to others to determine what the message ought to be that we get out of it.  I have several questions myself. 

Veritas, clearly I was wrong above when I said that there were no cases of people on HAART getting re-infected.  That also negates what Borzel and I agreed--that not worrying about re-infection would be one reason to start HAART for someone with borderline numbers.  Obviously, at the time when I read through those articles (and obviously I did not read every last one) I was highly nervous about my own case and I was looking for information that most closely matched my own case--about re-infection in people not yet on HAART.  

We still, of course, do not know whether I myself have been re-infected, and we may never know.  We are still waiting for the results of the HIV genotype test to come back, and even when they do they may demonstrate nothing.  But I'm really glad I started this thread.  I've had HIV for almost six years now (shudder), and in all that time, I can honestly say that I've never given two minutes' thought to the question of reinfection.  That's not right.  We need to be informed about things before they hit us, not afterwards!  Thanks to everyone who's contributed questions and answers on this important topic!
« Last Edit: June 13, 2010, 07:34:58 PM by Nestor »
Summer 2004--became HIV+
Dec. 2005--found out

Date          CD4    %       VL
Jan. '06    725    25      9,097
Nov. '06    671    34     52,202
Apr. '07    553    30      24,270
Sept. '07  685    27       4,849
Jan. '08    825    29       4,749
Mar. '08    751    30     16,026
Aug. '08    653    30       3,108
Oct. '08     819    28     10,046
Jan '09      547    31     13,000
May '09     645   25        6,478
Aug. '09    688   30      19,571
Nov. '09     641    27       9,598
Feb. '10     638    27       4,480
May '10      687      9    799,000 (CMV)
July '10      600     21      31,000
Nov '10      682     24     15,000
June '11     563    23     210,000 (blasto)
July  '11      530    22      39,000
Aug '11      677     22      21,000
Sept. '12    747     15      14,000

Offline odyssey

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  • Posts: 763
  • One Crazy Mofo!
Re: Re-infection!
« Reply #57 on: June 13, 2010, 07:30:25 PM »
Obviously these guys getting diagnosed with HIV didn't teach them a thing about safer sex if they couldn't even wait a couple weeks to not get laid.

Obviously you being diagnosed with HIV and reading these reports about superinfection, whether they were in people who were UD or not, didn't teach you a thing about safer sex or you wouldn't be so damn gung-ho to keep barebacking left and right. How would you feel if you gave someone else a superinfection?
01/09/09- diagnosed HIV+
01/16/09   CD4-425    22%     VL- 32415
11/09- started Truvada/Reyetaz/Norvir
03/10- stopped Truvada/Reyetaz/Norvir
10/18/11   CD4- 328   20%     VL- 84,000
10/25/11   CD4- 386   22%
10/28/11- start Truvada/Reyetaz/Norvir
3/8/12      CD4- 503   31%     VL 57

Offline Boze

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  • Posts: 477
Re: Re-infection!
« Reply #58 on: June 13, 2010, 08:57:58 PM »
I'm wondering what a statistician would say was the likelihood of it's happening.  You would need someone on, say, atripla, to have unprotected sex with someone who was completely resistant to atripla, and the first person would have to get re-infected.  What is the likelihood?  

Veritas, clearly I was wrong above when I said that there were no cases of people on HAART getting re-infected.  That also negates what Borzel and I agreed--that not worrying about re-infection would be one reason to start HAART for someone with borderline numbers.  Obviously, at the time when I read through those articles (and obviously I did not read every last one) I was highly nervous about my own case and I was looking for information that most closely matched my own case--about re-infection in people not yet on HAART.  


My understanding of the probabilities involved lets me posit that someone who is on HAART and UD has the same risk of getting a super-infection as he does of being struck by lightning.

Individual probabilities that I take under consideration:
--Number of living individuals with resistance to all three drugs in Atripla (example drug) who are out there having sex (and not in a hospital)
--Probability of virus transmission for the given sex act you perform
--Probability that the virus can infect someone while they are on HAART even if the viral strain has resistance to it (i think it's much less than 1)

I think the three probabilities add up to an infinitesimal number. And by the way - 40 people die each year in the US after being struck by lightning.

Another way to put it - being on HAART reduces your chances of a superinfection by a very large number (i think over 90%). So even while the risk is there - it's much, much smaller. And, of course, you are not a danger to any other individuals who you have sex with. You ended up getting the rough end of this stick - but what if the guy were negative and you passed it on to him (this is just a hypothetical).

Obviously you being diagnosed with HIV and reading these reports about superinfection, whether they were in people who were UD or not, didn't teach you a thing about safer sex or you wouldn't be so damn gung-ho to keep barebacking left and right. How would you feel if you gave someone else a superinfection?

Your message is missing a key logical link. Someone who is UD can not pass a superinfection by definition. Being UD means their cocktail keeps the virus in check since it's not resistant to the mix.



 
==========
Aug08 - Seroconversion
Mar10 - Diagnosis; cd4 690 - VL 19,000
Apr10 - cd4 600
May10 - VL 4,500
Jun10 - started Atripla ; VL 113
Jul 10 - UD vl, CD4 590
Aug 10 - UD, CD4 810, 52%
Nov 10 - UD, CD4 980

Offline leatherman

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  • Google and HIV meds are Your Friends
Re: Re-infection!
« Reply #59 on: June 13, 2010, 09:01:29 PM »
you wouldn't be so damn gung-ho to keep barebacking left and right
who says I bareback? not I  :P
you obviously inferred the wrong thing from my posts. Doh!

However, the barely dozen reports about people with "superinfection" that we've been discussing in this thread doesn't really inspire me yet to believe it's happening to long-term UD pozzies either. Although V did make a good point in the arguement about that  ;), Nestor's aidsmap link ("Unprotected sex between long-term partners with HIV: no evidence for superinfection") says quite the opposite.

(perhaps you should read that article first Ody and then consider my questions/comments about this topic that I've posted in this thread before jumping to your crazy conclusions.)
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Oh my friends, my friends forgive me
That I live and you are gone.
There's a grief that can't be spoken.
There's a pain goes on and on.
Empty chairs at empty tables
Where my friends will meet no more.

"Empty Chairs at Empty Tables" from Les Miserables

Offline edfu

  • Member
  • Posts: 1,084
Re: Re-infection!
« Reply #60 on: June 13, 2010, 09:23:15 PM »
Your message is missing a key logical link. Someone who is UD can not pass a superinfection by definition. Being UD means their cocktail keeps the virus in check since it's not resistant to the mix.

For the umpteenth time:  Undetectable via current viral-load measurement means undetectable ONLY in peripheral blood.  It does not mean undetectable in semen (or in the brain or in the gut, etc.).    

http://www.aidsmap.com/en/news/167784F9-FD3C-4148-8AB3-F669FE941BB3.asp
« Last Edit: June 13, 2010, 09:32:31 PM by edfu »
"No one will ever be free so long as there are pestilences."--Albert Camus, "The Plague"

"Mankind can never be free until the last brick in the last church falls on the head of the last priest."--Voltaire

Offline odyssey

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  • One Crazy Mofo!
Re: Re-infection!
« Reply #61 on: June 13, 2010, 09:46:31 PM »
Also, undetectable does not mean there is no virus present, it just means the amount of virus present falls below a certain limit. People who are undetectable can still pass on the virus to others!
01/09/09- diagnosed HIV+
01/16/09   CD4-425    22%     VL- 32415
11/09- started Truvada/Reyetaz/Norvir
03/10- stopped Truvada/Reyetaz/Norvir
10/18/11   CD4- 328   20%     VL- 84,000
10/25/11   CD4- 386   22%
10/28/11- start Truvada/Reyetaz/Norvir
3/8/12      CD4- 503   31%     VL 57

Offline Boze

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  • Posts: 477
Re: Re-infection!
« Reply #62 on: June 13, 2010, 09:55:00 PM »
For the umpteenth time:  Undetectable via current viral-load measurement means undetectable ONLY in peripheral blood.  It does not mean undetectable in semen (or in the brain or in the gut, etc.).    

http://www.aidsmap.com/en/news/167784F9-FD3C-4148-8AB3-F669FE941BB3.asp

Well we have two things here. First I presume you missed my point about superinfection. Namely - that someone who is UD on HAART can not pass a superinfection because they don't have one. Being UD means the virus is controlled. If it were resistant - the person would not be UD.

Secondly, I also think it's worth keeping in mind what the probability of transmission of someone who is UD (blood) is - very, very low. Ie the virus has been found in semen while being UD in blood - but how often? It's very unlikely.

Research has actually shown that viral load in blood has been a better predictor or transmission risk than semen: http://www.aidsmap.com/en/news/9FB2F33E-A7E4-4033-8933-C39BE61F17E8.asp

And this is the probability of transmission as function of blood VL:




http://papamamanbebe.net/a8238-les-personnes-seropositives-ne-souffrant-d-a.html#photo7153



==========
Aug08 - Seroconversion
Mar10 - Diagnosis; cd4 690 - VL 19,000
Apr10 - cd4 600
May10 - VL 4,500
Jun10 - started Atripla ; VL 113
Jul 10 - UD vl, CD4 590
Aug 10 - UD, CD4 810, 52%
Nov 10 - UD, CD4 980

Offline Boze

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  • Posts: 477
Re: Re-infection!
« Reply #63 on: June 13, 2010, 09:59:00 PM »
Also, undetectable does not mean there is no virus present, it just means the amount of virus present falls below a certain limit. People who are undetectable can still pass on the virus to others!

Doctors believe that the odds are worse (ie you are more likely to transmit HIV) if you have normal VL and have sex with a condom.

==========
Aug08 - Seroconversion
Mar10 - Diagnosis; cd4 690 - VL 19,000
Apr10 - cd4 600
May10 - VL 4,500
Jun10 - started Atripla ; VL 113
Jul 10 - UD vl, CD4 590
Aug 10 - UD, CD4 810, 52%
Nov 10 - UD, CD4 980

Offline Matty the Damned

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  • Posts: 12,160
Re: Re-infection!
« Reply #64 on: June 13, 2010, 10:00:55 PM »
Doctors believe that the odds are worse (ie you are more likely to transmit HIV) if you have normal VL and have sex with a condom.



Which doctors?

MtD
(Who almost made a punz)

Offline Boze

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  • Posts: 477
Re: Re-infection!
« Reply #65 on: June 13, 2010, 10:01:55 PM »
Which doctors?

MtD
(Who almost made a punz)

Dr.Gallant
==========
Aug08 - Seroconversion
Mar10 - Diagnosis; cd4 690 - VL 19,000
Apr10 - cd4 600
May10 - VL 4,500
Jun10 - started Atripla ; VL 113
Jul 10 - UD vl, CD4 590
Aug 10 - UD, CD4 810, 52%
Nov 10 - UD, CD4 980

Offline Matty the Damned

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  • Posts: 12,160
Re: Re-infection!
« Reply #66 on: June 13, 2010, 10:05:05 PM »
Dr.Gallant

So it's Doctor - the singular.

MtD

Offline Boze

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  • Posts: 477
Re: Re-infection!
« Reply #67 on: June 13, 2010, 10:11:02 PM »
So it's Doctor - the singular.

MtD

Given that he is part of the establishment of HIV profession, one can safely assume that other doctors share his views. He is just kind enough to share them in an internet forum.

==========
Aug08 - Seroconversion
Mar10 - Diagnosis; cd4 690 - VL 19,000
Apr10 - cd4 600
May10 - VL 4,500
Jun10 - started Atripla ; VL 113
Jul 10 - UD vl, CD4 590
Aug 10 - UD, CD4 810, 52%
Nov 10 - UD, CD4 980

Offline edfu

  • Member
  • Posts: 1,084
Re: Re-infection!
« Reply #68 on: June 13, 2010, 10:46:51 PM »
First I presume you missed my point about superinfection. Namely - that someone who is UD on HAART can not pass a superinfection because they don't have one. Being UD means the virus is controlled. If it were resistant - the person would not be UD.

Look:  The person who causes a superinfection in a second person does not himself have a superinfection, but he causes the second person to have the superinfection. 

Person A has virus variant A.  He is UD on HAART.  His HAART controls his variant-A virus in peripheral blood, but his semen still contains the virus.  He is not superinfected.

Person B has virus variant B.  He has unprotected sex with Person A, who infects him with variant A.  Person B is now infected with two virus variations.  He is now superinfected. 
"No one will ever be free so long as there are pestilences."--Albert Camus, "The Plague"

"Mankind can never be free until the last brick in the last church falls on the head of the last priest."--Voltaire

Offline veritas

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  • Posts: 1,408
Re: Re-infection!
« Reply #69 on: June 14, 2010, 05:36:11 AM »

Nestor,

We are all still learning about this disease and to catch everything when your researching a particular issue is next to impossible. I'm hoping your labs were some type of error and if they weren't, you should still be able to take a good combination to get that vl down. Please keep us posted as to what they find. I don't think they will test for a re-infection. However, your geno and pheno should give you the necessary information to come up with a winning strategy.


v

Offline veritas

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Re: Re-infection!
« Reply #70 on: June 14, 2010, 05:43:12 AM »

mikie,

along with those conjectures you enumerated, I just don't think they are testing for different strains when  someone has a ridse in their vl.  The cost would be prohibitive and the final treatment decision is based on geno and pheno tests. Heck, there's a lot more info I'd like to know but it's just not available.

All we can do is play it safe.

v

Offline edfu

  • Member
  • Posts: 1,084
Re: Re-infection!
« Reply #71 on: June 14, 2010, 05:48:57 AM »
I just don't think they are testing for different strains when  someone has a ridse in their vl.  The cost would be prohibitive and the final treatment decision is based on geno and pheno tests.

Veritas, you speak the veritas.  Testing for strains is done only in a research setting.  The cost is estimated to be between $5,000 to $10,000.
"No one will ever be free so long as there are pestilences."--Albert Camus, "The Plague"

"Mankind can never be free until the last brick in the last church falls on the head of the last priest."--Voltaire

Offline leatherman

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  • Google and HIV meds are Your Friends
Re: Re-infection!
« Reply #72 on: June 14, 2010, 06:43:52 AM »
different strains when  someone has a ridse in their vl. 
do you know if there's any information then about how often "therapy failure", ie a rise in Viral load, is happening? If a rising VL is a sign of reinfection, that's another thing you would think we'd be hearing about in longterm virilocially suppressed individuals, who would then be switching meds (without a test done for the strain).

Most med changes I read about seem to be for convenience or costs sake and/or side effects issues. I don't think I ever much hear of someone sustaining UD for 10 yrs suddenly having unexplained therapy failure and changing meds - unless their bad adherence causes resistance and then, after a genotyping, a med switch usually resolves the issue bringing the client back to UD.

The reason I keep questioning and postulating, is that the issue of "reinfection" in longterm virilocially suppressed individuals seems to be as rare as getting HIV from oral sex. It's sounds like it's one of those minute <1% issues.

Thanks for your help in understanding this issue.  ;)
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Oh my friends, my friends forgive me
That I live and you are gone.
There's a grief that can't be spoken.
There's a pain goes on and on.
Empty chairs at empty tables
Where my friends will meet no more.

"Empty Chairs at Empty Tables" from Les Miserables

Offline Boze

  • Member
  • Posts: 477
Re: Re-infection!
« Reply #73 on: June 14, 2010, 08:57:20 AM »
Look:  The person who causes a superinfection in a second person does not himself have a superinfection, but he causes the second person to have the superinfection. 

Person A has virus variant A.  He is UD on HAART.  His HAART controls his variant-A virus in peripheral blood, but his semen still contains the virus.  He is not superinfected.

Person B has virus variant B.  He has unprotected sex with Person A, who infects him with variant A.  Person B is now infected with two virus variations.  He is now superinfected. 

Ok - I see. I see how it can happen. For that to happen, Person B's cocktail has to have no impact on Person A's virus, who is keeping it UD in blood but has some VL in semen. It seems possible but extremely unlikely. Ie lottery type odds (assuming you don't actually find such people and set them up with very purpose of testing the hypothesis).
==========
Aug08 - Seroconversion
Mar10 - Diagnosis; cd4 690 - VL 19,000
Apr10 - cd4 600
May10 - VL 4,500
Jun10 - started Atripla ; VL 113
Jul 10 - UD vl, CD4 590
Aug 10 - UD, CD4 810, 52%
Nov 10 - UD, CD4 980

Offline Nestor

  • Member
  • Posts: 430
  • What we love, we shall grow to resemble.
Re: Re-infection!
« Reply #74 on: June 14, 2010, 09:31:22 AM »
Veritas, you speak the veritas.  Testing for strains is done only in a research setting.  The cost is estimated to be between $5,000 to $10,000.

Right--which is why in my case, for example, we may never now for sure.  This article: http://www.aidsmap.com/en/news/18CDEFBE-B491-4D73-AC92-AB0177577FF0.asp, for example, says:

"The researchers conclude that HIV-infected patients who continue risk behaviour are at risk of superinfection “both in the early and established phases of the disease”. They recommend that all patients not on treatment who experience unexpected viral load increases should be screened for superinfection (though the kind of intensive phylogenetic screening used in this study is purely a research tool, costing £10,000 per patient)."

The article suggests that re-infection is common (two out of eight people followed were re-infected) but it also reveals that someone can lose med resistances by getting reinfected:

In the second case the patient acquired a second strain three years after the first. In this case his original virus had two drug resistance mutations. When his viral load increased he was given another resistance test 3.5 years after diagnosis which showed no evidence of the mutations. Analysing previous samples showed he had acquired a superinfection six months previously.

So, what do you think, if your virus is drug resistant, would going out and deliberately getting reinfected by someone without resistances be a good idea?  Of course you'd have to make sure it was someone with no other stds.

By the way, the fact this this person was reinfected three years after initial infection would appear to contradict the prevalent idea that reinfection only happens to the newly infected. 

More importantly for me, the article does not suggest that faster progression to AIDS is a result of superinfection:

In one case the patient‘s second strain of HIV was drug-resistant. He also experienced a recurrence of acute HIV symptoms which required hospitalisation for suspected meningitis and a large, though temporary decrease in CD4 count. In the other case the patient’s original strain of HIV, which was drug-resistant, was replaced by an apparently stronger non-resistant strain and his viral load increased from around 3000 to half a million. However he maintained a CD4 count over 1000 and his viral load had returned to 3000 a year later.

So, leaving aside resistance issues, in one case the decline in cd4 cells was temporary, and in the other the surge in viral load was temporary.  I'm keeping my fingers crossed! 

This article http://www.thebody.com/content/treat/art53776.html#49 says: 

There is also evidence that superinfection occurs only rarely in HIV-infected individuals on effective ART.49,50

but doesn't go on to say what that evidence is, although I suppose one could follow the footnote. 



Summer 2004--became HIV+
Dec. 2005--found out

Date          CD4    %       VL
Jan. '06    725    25      9,097
Nov. '06    671    34     52,202
Apr. '07    553    30      24,270
Sept. '07  685    27       4,849
Jan. '08    825    29       4,749
Mar. '08    751    30     16,026
Aug. '08    653    30       3,108
Oct. '08     819    28     10,046
Jan '09      547    31     13,000
May '09     645   25        6,478
Aug. '09    688   30      19,571
Nov. '09     641    27       9,598
Feb. '10     638    27       4,480
May '10      687      9    799,000 (CMV)
July '10      600     21      31,000
Nov '10      682     24     15,000
June '11     563    23     210,000 (blasto)
July  '11      530    22      39,000
Aug '11      677     22      21,000
Sept. '12    747     15      14,000

Offline hotpuppy

  • Member
  • Posts: 555
Re: Re-infection!
« Reply #75 on: June 15, 2010, 10:18:29 PM »
Nestor, sorry to hear you are not feeling well. 

[dodge flames]
I personally would not worry too much about superinfection.  [/dodge flames]   :-\

I'm a big fan of logic and science.  There are two arguments that support what Ann said about Occam's razor.

In essence, Occam's Razor means that the simplest explanation is the most likely.

1. The damning evidence:  There are a handful of cases of documented superinfection.  Yet the vast majority of poz gay men that I know of engage in unprotected sex.  This doesn't mean everyone reading this is in that category, but just my basic observations suggest that unprotected sex is pretty common.  It's been going on for a while now... so if reinfection and co-infection were significant risks we should be seeing in it many gay men.  The daming evidence is that there isn't any.  We just don't see lots of people who are coinfected.

2. The conspiracy theory (my personal favorite):  Sadly, some people get off on controlling other people's sex lives.  This masquerades under the hallucination of morals.  Most of this is leveraged on the "my excuse is more powerful then your desire" logic.  When you were negative this took the form of "if you disobey me you will wind up poz."  Well, that logic doesn't exactly hold water for most of us in here.  So the next logic that you can substitute is a slight variation on the same ole scare tactic.  "you'll get it again if you don't do what I say."  aka reinfection.  The Federal government attaches real dollars to safe sex campaigns which encourages ASO's to push safe sex to PWA's. (People with HIV/AIDS).

3. The viral factor:  Okay, one of the arguments for reinfection is that you don't want multiple strains.  Um, okay, but like many other facets of HIV education it imparts too much intelligence to a virus.  The virus mutates constantly and a given individual may have a multitude of mutations at any given time.  True, drug resistance can be passed on during the initial infection... but see my first point.... if viral resistance could be passed from person to person, many of us would be in deep trouble. 

4. One of the more curious things about HIV is that if someone stops therapy the wild-type strain re-emerges most of the time.  This isn't well understood.  However, it supports the concept that you might have a resident virus and that displacing the resident virus would be reasonably difficult.  After all, what makes HIV difficult to treat is that it assimilates itself into your DNA.  The odds of another strain coming along and ripping out your current strain and replacing it are right there with fresh ice in hell.  It makes for good news copy and great sci-fi but in my unqualified opinion it doesn't fly. 

5. Let's look at the "examples" that have been trotted out by the CDC, whom I consider to be an authoritative source.  The best they can offer is this:
When Both Partners are Infected: What is the Significance of Superinfection in HIV Transmission?
Superinfection is defined as infection by a second strain of HIV after initial
infection by a primary strain has been established [44]. The frequency and timing of superinfection may vary depending upon the population under study and the method of detection. Follow-up of 78 newly infected individuals (none of whom initiated ART while under study) in one clinic revealed that 4 (5%) had acquired a superinfecting strain within 6 to 12 months of initial infection [45]. In a cohort of 36 high-risk Kenyan women screened for HIV-1 superinfection over a 5-year period beginning at primary infection, seven cases of superinfection were detected [46]. In this study superinfection occurred throughout the course of the first infection: during acute infection in two cases, between 1-2 years after infection in three cases, and as late as 5 years after infection in two cases. The clinical consequences of superinfection for an individual vary, but may include accelerated disease progression and the acquisition of drug resistance [47]. The public health consequences of HIV superinfections are unclear. While superinfection can result in recombination between genetically different viruses, and a number of circulating recombinant forms (CRFs) are prevalent in certain geographic areas [48], it has not been demonstrated that such recombination results in the establishment of more transmissible or virulent viruses. There is also evidence that superinfection occurs only rarely in HIV-infected individuals on effective ART [49, 50].

That's pretty vague for an agency that normally uses pretty damning language.  They say that in one instance they found a 5% reinfection rate, but then state at the end that it's pretty rare for individuals on ART.  The bottom line is they are being pretty vague about it.

Let's look at the footnotes:
49.
Chakraborty B, Valer L, De Mendoza C, Soriano V, Quinones-Mateu RE. Failure to detect human immunodeficiency virus type 1 superinfection in 28 HIV-seroconcordant individuals with high risk of reexposure to the virus. AIDS Res Hum Retroviruses 2004;20:1026-31.
50.
Gonzales MJ, Delwart E, Rhee SY, et al. Lack of detectable human immunodeficiency virus type 1 superinfection during 1072 person-years of observation. J Infect Dis. 2003 Aug 1;188:397-405.

In both instances the title of the paper is "failure to find superinfection" not anything more sensational.


Lastly, let's revisit the super-infection cases we do know about.  What do they exhibit?  Massive risk exposure. 

Realisitically the average HIV'r is doing pretty good on the get-laid-scale if they are getting laid once a week on average.  That represents 52 exposures per year.  I think that most people are at this or below.  Someone who is promiscuous may have 300 partners per year, which is a 600% increase in exposures.

The guy who was superinfected in NYC a few years ago (the one that started the superinfection craze) was going to the bathhouse 7 days a week for 7 years and having sex with 20 or so strangers a night.  That's 7300 exposures per year or 49000 exposures overall.  That's a 1216% increase over a "promiscuous person" (300 partners/yr) and a 14600% increase over an average person.

So unless you are busier than a free Taxi in London..... giving rides to anyone who wants them.  I think your risk level is lower.

My understanding is that the other superinfection cases are similar in profile to this sort of extreme risk behavior.

One last tidbit.... the reason you haven't seen much superinfection is that it's reasonably difficult to identify.... when was the last time your Doc did inventory on the variations of virus present?  IBM did a study which I can't seem to locate right now, but they took blood samples and analyzed them for HIV variations.  They found that the average individual had many mutations in their blood... .this synchs up with HIV's known history of mutating rapidly and constantly.

Anyhow, I'm not encouraging you to toss your condoms and become a slut.  I am encouraging you to do your research, form an opinion, and choose a course of action that is rational and balances your need for personal safety with your need for intimacy.

As for other bugs.. yea HIV aint the only bug on the farm.  And most of the others are easier to catch... so you should ensure that your bloodwork includes regularly screening for syphillis. 

As for elevated liver numbers.... have you gained weight?  My personal demon has been Fatty Liver Disease .... apparently quite common and free when you are infected with HIV!  Wow..... anyhow the solution is to lose weight gradually and watch my diet like a hawk.  Speaking of which, it's time for an ice cream cone.... just cuz I watch what I eat doesn't mean I have to eat like crap.  And just because I'm poz doesn't mean I can't have good sex that meets my needs.
Don't obsess over the wrong things.  Life isn't about your numbers, it isn't about this forum, it isn't about someone's opinion.  It's about getting out there and enjoying it.   I am a person with HIV - not the other way around.

 


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