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Author Topic: cross infection between 2 POZ guys  (Read 2091 times)

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Offline tshirtguy

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cross infection between 2 POZ guys
« on: April 20, 2013, 09:55:45 AM »
An interesting subject came up at a POZ group that I belong to and I'd like to hear what the community here has to say about the topic.

What are the risks of cross-infecting a POZ partner with a different strain of the virus through unprotected anal sex?- oral sex? If you're both undetectable? if you're both on Meds?
Does having one strain in your system 'block out' another strain from entering?
Is there a 'dominant' strain that will take over if the weaker strain is present?
Are there studies on the subject?

I know there are a bunch of questions here, and I apologize for that. The group discussion seemed to have a wide variety of opinions, so I was wondering what the HIV community/ medical professionals now believe on the subject.

Thanks for your insight!

Offline LiveWithIt

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Re: cross infection between 2 POZ guys
« Reply #1 on: April 20, 2013, 02:15:18 PM »
I would think if it was a concern (even with people not on meds) that there would be a major problem that we would have heard about.  For now it doesn't seem to be an issue to worry yourself about.
Pray God you can cope
I know you have a little life in you yet.
I know you have a lot of strength left.

Offline newt

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Re: cross infection between 2 POZ guys
« Reply #2 on: April 20, 2013, 05:57:59 PM »
As ever, transmission depends on quality, quantity and opportunity...

Both on meds the viral load is so low this is really a non-issue, there ain't any, whatever type of sex. Whatever meds.

Off meds, the risk increases as the two viral types diverge. The same virus, well so what if you get a bit more of the same virus, different virus, possibly might be interesting.

It's an outside chance anyway, there are perhaps 2 dozen document cases of clinical importance in 40 million cases of HIV.

Different people will reach different conclusions on this point. there isn't a right answer. It's what you feel comfortable with.

- matt
"The object is to be a well patient, not a good patient"

Offline Anqueetas

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Re: cross infection between 2 POZ guys
« Reply #3 on: April 25, 2013, 08:10:11 AM »
Looking from a good sense point of view

 Undetectable viral load in the blood doesn't mean Undetectable viral load in Semen or gut mucosal. So virus could still be transmit via unprotected anal sex.

Oral sex is a very low risk behavior to transmit virus in the first place. Saliva kill HIV unless you clearly have visible broken skin with blood in your mouth or penis while performing oral sex. the risk is very very low but no body can says that it impossible.

The mechanism that HIV enter the body, is still there when you are positive, so yes you can get super infection. The problem is going to be if the new virus is resistance to the drug that you are taking for you own virus, then you will end up with having Drug resistance HIV and possible developing Muti drug resistance HIV.

Several research have been made on HIV genetic, i'm not sure but you can search around. Some HIV mutation that cause drug resistance can make the virus less infectious or progress slower(replicated slower) it also goes the other way. So yes, in the presence of several strain of HIV virus the virus that able to replicate faster and able to evade your body immune system better will become the dominate strain in your body. In the situation where is ARV involve the strain the have drug resistance will quickly take over the body while the other strain will be stop by ARV.
From this, that why you need HAART, mono therapy put selective pressure in the virus population and soon it will become resistance. 3 drug combo from at least 2 difference class is effective to stop that from happening in the first place.

HIV virus is also part of Mother nature as well, so i don't see why it will get except from the law of Nature.The strongest virus will survive and procreate. The weaker one will vanish. That why you see report like, rising drug resistance on HIVer in the future, due to treatment expansion. Tranmission of HIV drug resistance is increasing, because Drug resistance virus will be able to replicate in the present of ARV and that mean higher viral load. Higher viral load translate to higher chance of transmission!
ARS, hospitalized for very high fever-July 2011
diagnosed HIV positive - October 16 2011
CD4 460 19.5% VL 49000 - late October 2011
CD4 625 19.5% VL 50030 - January 2012
CD4 369 19% VL 69000 - March 2012
Start Sustiva+ Truvada - April 17 2012
CD4 524 24.5% VL UD - August 22 2012
Switch to Nevirapine+Truvada
CD4 490 26% VL UD - November 2012
CD4 539 29% VL UD - February 2013
CD4 621 28% VL UD - May 2013

Offline jkinatl2

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Re: cross infection between 2 POZ guys
« Reply #4 on: April 25, 2013, 06:31:51 PM »
A couple of questions:

Quote
Undetectable viral load in the blood doesn't mean Undetectable viral load in Semen or gut mucosal. So virus could still be transmit via unprotected anal sex.

I recall reading about the detectable levels of HIV found in the semen of patients who had an otherwise UD VL, but not the gut mucousal. Was this in the same study? I would appreciate the source.

Also, while this translates to initial infection, is there any indication that it translates to re-infection? As there have been only two dozen or so confirmed cases, I would assume that the circumstances of those "cross-infections" have been parsed rather thoroughly. Could you source this information as well?

Thanks!
"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline aaware72

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Re: cross infection between 2 POZ guys
« Reply #5 on: April 25, 2013, 08:15:34 PM »
Spoke to my doctor just yesterday about this.  As I have a resistance to rilpivirine and my partner does not.  He said that is possible to be infected with another strain. 
"Yes, knowledge is power. Self-knowledge brings mastery of one's body."

Offline jkinatl2

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Re: cross infection between 2 POZ guys
« Reply #6 on: April 25, 2013, 08:28:44 PM »
Spoke to my doctor just yesterday about this.  As I have a resistance to rilpivirine and my partner does not.  He said that is possible to be infected with another strain. 

You'd be a scientific anomaly if it happened, that much seems clear. Sadly, doctors are not always up on research, especially research deemed not crucial to living healthy with HIV. It's possible, of course. But the research has yet to prove it is at all likely, moreso if both partners are on meds.

From my reading, the re-infection cases have all dealt with the extenuating circumstance of very high viral loads. And even then, we simply haven't seen enough of it in vivo to make it a serious issue at all.

At the end of the day, we subject ourselves to all manner of pathogens when we are intimate with a partner, from a cold to STDs if s/he sleeps around (even with condoms.)

But we make an informed choice to do this, in the name of intimacy. I am constantly dismayed at the level of hysteria that accompanies HIV when it's being successfully treated.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline Dr.Strangelove

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Re: cross infection between 2 POZ guys
« Reply #7 on: April 26, 2013, 12:03:11 PM »
Ask a dozen doctors and you'll get a whole spectrum of answers.
For example, the HIV doc I had in the US told me superinfection is nothing to worry about when having unprotected sex with other positives.

Those doctors might not always be up to date with every aspect of the broad HIV topic. I would always trust a bunch of peer reviewed scientific studies more than the opinion of a single doctor.

And in terms of studies, there's just not a lot. As Matt said: a few dozen documented cases for the 40 millions of HIV positive people.
If super infection occurred frequently, wouldn't we have a lot more documented cases? (And btw, I doubt that in those cases both partners were even undetectable in the first place.)

There is just too many barriers along the way:
-With respect to other infectious diseases HIV has a very low transmission rate to begin with.
-Successful medication reduces the viral load from the typically tens or hundreds of thousands to <20 copies/ml. As studies like HPTN 052 showed, it reduces the chance for transmission to a minimum (and yes, that's despite there might still be a detectable viral load in semen even if it's UD in blood). Some argue that having sex with a condom with a person with detectable viral load is as likely to result in a HIV transmission than having sex without a condom with a person that is UD. There's no consensus on that topic yet I don't want to get into that discussion here, I just mention it to show to what extent a successful therapy reduces the chance of transmission.
-But here we are talking about both partners being on meds. As unlikely as it may be let's say a single virus particle from undetectable person A does manage to get into the blood stream of his UD partner (B). What awaits the virus here are the meds of person B, which are basically working as a PrEP and thus further reducing the risk by 63%. Also in the blood stream of person B are plenty of HIV antibodies. They are of course not 100% effective but they did push down the viral load of person B after his initial infection and there is some chance that they catch that stray virus particle from person A.
With all those obstacles in the way, I personally don't worry about superinfection. But yes, everyone has to draw his own conclusions...

If one is worried about resistant HIV strains make sure to be adherent. Because skipping meds and taking breaks is much more likely to result in resistencies.

Offline aaware72

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Re: cross infection between 2 POZ guys
« Reply #8 on: April 26, 2013, 12:27:00 PM »
You'd be a scientific anomaly if it happened, that much seems clear. Sadly, doctors are not always up on research, especially research deemed not crucial to living healthy with HIV. It's possible, of course. But the research has yet to prove it is at all likely, moreso if both partners are on meds.

From my reading, the re-infection cases have all dealt with the extenuating circumstance of very high viral loads. And even then, we simply haven't seen enough of it in vivo to make it a serious issue at all.

At the end of the day, we subject ourselves to all manner of pathogens when we are intimate with a partner, from a cold to STDs if s/he sleeps around (even with condoms.)

But we make an informed choice to do this, in the name of intimacy. I am constantly dismayed at the level of hysteria that accompanies HIV when it's being successfully treated.

Thanks for your feedback.  I do however feel that I have doctor that is current with much of the HIV research and studies.  I could be the poster child of the odd man out.  n

I was told that don't worry you are a newly infected person and today's medication are great.  My first CD4 count was 230.  Wednesday at the 90 mark I find out I have severe hepatotoxicity.  I think it the Stirbild as that is the only variable in what I have been taken. 

It's all good to say don't worry, however I worries because I been told right from the being when I found out I was HIV+ not to worry and thing will be okay.  So in the short 90 days I have found out I resistant to rilpivirine.  So two weeks into treatment I was switch to Stirblid and now I have severe heptotoxicity after just under 60 day on this drug.  Yes know we work to confirm that this is whats causing the liver issue,but I have this though in the back of my mind that it is the Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs).  I sure we will figure it out here soon I hope, however what are my will be my option then?

Sorry I've got a bit off subject, but me and my partner found out just 90 day ago that we were both POS.  I have the resistance he does not.  I had a VR 52,000 and he had a VR of 30,000.  Who know really?  But i worry because the things I been told not to worry about because they have all seem to not apply to me.




"Yes, knowledge is power. Self-knowledge brings mastery of one's body."

Offline Dr.Strangelove

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Re: cross infection between 2 POZ guys
« Reply #9 on: April 26, 2013, 09:54:13 PM »
Hello there,
that's an interesting case that both of you tested positive together but one of you have a resitency and the other does not. Did I get this right?
Is it possible that you did not get HIV from one another but entirely independent of each other? Do you know which subtype of HIV both of you have? If it's a different subtype you obviously did get infected from two different sources.

As for your other problems. I'm sorry to hear that things don't go as smooth as expected but in the end, every patient is different. Stribild seems to be well tolerated by the majority of patients but there are always exceptions. Still, I wouldn't worry too much. I'm sure there is a combination of drugs that will work fine for you.

Good luck

Offline aaware72

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  • Posts: 224
Re: cross infection between 2 POZ guys
« Reply #10 on: April 29, 2013, 06:32:31 PM »
Hey Dr. Strangelove

Yes we both tested positive at the same time.  We had only know each other for about 2 months.  It does look like we did not get it from each other.  We believe we found each other for a reason.  as the saying goes...everything happens for a reason. 
We are about to mark 5 month together. 

As for the other issues it just concerning that I am already having liver issues. I sure it will be okay just trying to get through it all. 

Thanks :)
"Yes, knowledge is power. Self-knowledge brings mastery of one's body."

Offline Dr.Strangelove

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Re: cross infection between 2 POZ guys
« Reply #11 on: April 29, 2013, 06:36:41 PM »
Hehe, I see.
Yeah, it must have been destiny then, that you two met  :)

 


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