Superinfection fears

[RoseMary]

So.. I think I fucked up big time.....

I had a severe manic episode (I'm severely bipolar and have OCD..) Both of which contributed to a 4-5 month phase where I literally lost my mind (pychosis) and became extremely hypersexual.

In that time, I had many partners (about 5 or more partners (all poz), and that included unprotected reckless sex..

Last month i got really sick.. i looked up the symptoms of superinfection symptoms (severe migraines, flu like symptoms) that last almost a month.. now that I'm stable mentally I've began to analyze and understand regrettably how reckless i was.. im still undetectable, but my doctor's assistant said it takes up to six months after sex to seroconvert.. fuck my life... My cd4 dropped from over 1000 now down to 600.. the lowest I've gotten since first contracting HIV..

Im terrified.. Of all the potential consequences i face..

My next doctors appointment is in three weeks.. and i dont know if i can't mentally withstand waiting that long..

I had gotten that sick in the last 10 years...

I don't know why I'm writing this.. moral support? Advice needed..

Please, no mean comments.. i seriously just need anyone with know of this topic that can help me somehow...

Thank you..

[Jim Allen]

Hiya

I moved you topic here in "how do I prevent HIV" as I feel the concern and question belongs better here. The other forum members are welcome to jump in on this thread.

My cd4 dropped from over 1000 now down to 600

400 drop in CD4 is rather irrelevant. Over what span of time 6 months?
I've personally dropped over 300 from time to time and had it go back up, no reason at all. Maybe I sneezed 

i looked up the symptoms of superinfection symptoms

So no unique symptoms, and common illness symptoms are normally caused by common things. Try to relax and stop with the Dr.Google   

As for superinfection - reinfection or however people wish to call it  its highly rare to start with and doubted by some.  Look practical side you are on treatment right? Well you HIV treatment will work as a barrier like PrEP against any incoming HIV.

We have had a few topic on it in recent times 

https://forums.poz.com/index.php?topic=68615
https://forums.poz.com/index.php?topic=65688

I had many partners (about 5 or more partners (all poz), and that included unprotected reckless sex.

You know HIV is not really an issue but of course its a greater risk for easier to acquire and more common infections, so you should be testing regularly and perhaps reconsider using condoms if the fear of contracting STI's etc is too great.

My next doctors appointment is in three weeks..

You mean with the ID doctor?

Look if you are sick and having flu like symptoms can you see a GP sooner?

Best, Jim

Easy to read print on super-infection:
http://www.hivplusmag.com/treatment/2014/04/10/what-hiv-superinfection-and-how-do-i-prevent-it

Collection on the topic of super-infection
https://www.poz.com/tag/superinfection

[leatherman]

reinfection is very rare. I doubt you'll be case #20 after 35+ yrs of HIV data collection.

there are a couple of points that always need to be made during a "reinfection"/"superinfection" conversation:

1. in most of the cases when someone HIV+ became infected with another strain of HIV, the reinfected person had a high viral load (so they were already failing therapy or were not adherent to their meds) along with the other partner who also had a high viral load (because that's how transmission works )

2. don't forget, your antiretroviral regime will probably work as a prophylaxis against any incoming HIV, the same way PEP and PrEP work

summing up, UD means not only will you not transmit HIV but it also means that you have the proper levels of meds (and the proper low level of HIV ) in your system so that even if you are exposed to more HIV, and perhaps a different strain, you have a great deal of protection heading off "reinfection"(obviously it's pretty good protection since there have only been 19 cases )

the only cases of "reinfection" were people who were NOT adherent to their meds and already had high viral loads themselves. One of the best cases for an explanation is the case of 2 men who were in the hospital. Even though they were in the hospital with AIDS (i.e. both had high viral loads, AIDS complications, and were not adherent for a long time), the two men had sex and infected each other with slightly mutated strains.


so, unless you've been totally off your meds for some time and currently deadly sick with AIDS and you had unprotected sex with someone who has been off their meds and deadly sick with AIDS, reinfection is not something you should worry about. Instead what you should be worried about is having been infected with syphilis (which is at huge growing epidemic rates), gonorrhea, and chlamydia

[RoseMary]

Thanks for the info guys.. I'm lucky to have not gotten other std's during this time.. so yes.. no more condomless sex.. the paranoia of the risks outweigh the joys of skin to skin contact..

My cd4 dropped from 1200 to 600 hundred in less than a month..

I've been not adherent to my meds for about 6 months following 9 years of adherence to my truvada and issentress..

I am a hydrochondriac.. so I'll stop "web-mding online, until i see my dr.

I only freaked out as my ID dr's assistant was really worried about..

[RoseMary]

To explain why i wasn't adherent for 6 months was due to a really bad Haital hernia I suffer with, that would not allow me to keep my pills down.. im better now and eating again. But vomiting and nausea  will always be there until i can get a surgery to get my stomach stapled back in place and out of my chest cavity

[Jim Allen]

I was about to ask.

Sorry to hear about the hernia and the effects from that. I hope you manage to get the surgery soon to fix and feel better. Particularly so if its becoming a barrier to adherence and ill spare you the "resistance" speech. Was the VL still UD?

Any idea when you can get the surgery and is your ID doctor aware of the challenges you are facing in regards to this?

Best, Jim

[RoseMary]

My insurance won't cover the surgery, until it advances to giving me cancer in my esophagus or killing me in some other way. So surgery isn't going to happen anytime soon


After I became a little better is when I fell into the worst manic phase I've ever experienced and became hypersexual.

My recent labs despite being off of meds for 6 months, state that I've remained undetectable in that time, as i got bloodwork right before starting my cocktail again. Suprising my ID dr.

It's a relief knowing that historically it's so uncommon and rare to get superinfected.. especially since I've been adherent for mostly 9 years prior.

I read an article stating that of you are undetectable it makes the risks much higher to snag another strain.. it was a legitimate study, is why i got so worried too.

My Dr's. Assistant said that strains can be passed regardless of undetectable viral loads and high cd4 counts.. so i dont know what to believe..

Also my ID dr. Is aware of my stomach problems, he just says to keep up with my gasterologist.. he only knows HIV, and answers only questions regarding HIV.. not other ailments i have.. to just follow up with those other dr's.

[leatherman]

I read an article stating that of you are undetectable it makes the risks much higher to snag another strain.. it was a legitimate study, is why i got so worried too.

can you get a link to that article, because that simply isn't true. When you have an UD (which is actually <=200) VL, you simply have next to no HIV. If you were infected with another strain, you would have a higher viral load (5k+).

CD4 counts mean nothing, except that having one over 200 keeps opportunistic infections from happening. It's not a measure of health or strength of immune system (though the logic is more = better). The "normal" range is a wide range of 450 to 1200+, with a daily change of 100 being normal. As i have yet to meet anyone who had their cd4s measured prior to HIV, I'm going bet good money that you don't even know what "normal" is for you  is your normal 400 or 1200? that's a big range and someone with either count can be sick or healthy as a horse. cd4 counts over 200 really don't matter

When a person is treated successfully (ie the right amount of meds in the right time to prevent HIV from replicating) for an amount of time, they reach UD. The meds not only stop HIV replication; but work as PrEP (pre exposure prophylactic) and PEP (post exposure) blocking any hew HIV virus from getting a foothold or stopping some virus that was about to get a foothold in your immune system. The chance of getting infected while successfully treated is damned near next to nil. 

My Dr's. Assistant said that strains can be passed regardless of undetectable viral loads and high cd4 counts.. so i dont know what to believe..

oh, and don't forget U=U. That means the assistant isn't quite right either. A person who is UD does NOT transmit/pass any HIV, so being UD is pretty important on that side of the equation.

[Jim Allen]

Indeed.

Sustained treatment 6+ months undetectable level (Less than 200 copies) a person can not transmit the virus.

Relax sounds like the assistance claim/comment that two people who can not transmit something are at risk to transmitting something to each other is just poorly mistaken or misunderstood. It a bit like claiming an elephant flapping its ears can't fly, but if you get two elephants holding hands flapping their ears who knows 

[Jim Allen]

My insurance won't cover the surgery, until it advances to giving me cancer in my esophagus or killing me in some other way. So surgery isn't going to happen anytime soon

Sorry to hear that and, I hope something comes up for you that can be done before anything more serious occurs.

[RoseMary]

Can't find the link i was referring to.. but i assume there are studies that contradict one another..it may have been an older statistic. It was regarding a study consisting of more than 10 individuals over a period of a few years..

Anyhoo, the reason i felt safe during my hypersexual manic episode..to go unprotected was because I'd come to the conclusions that you guys have presented to me.. that U=U. And how my Truvada itself can act as Prep from acquiring other strains.. glad to know my assumptions are accurate..

My normal cd4 is above 1000.. is why i freaked at it dipping so low in my recent bloodwork..

[Jim Allen]

Hiya

Can't find the link i was referring to.. but i assume there are studies that contradict one another..it may have been an older statistic. It was regarding a study consisting of more than 10 individuals over a period of a few years..

No, no.

Look you are entitled to your doubts & fears and we are all here to support each-other otherwise why have a forum, however let me be clear on this point for you  and other members who may have similar doubts reading this thread.

To start with the lowest ever recorded threshold of sexual transmission occurred in the early 2000 at a suspected viral load of 362 copies/ml, the key point was the individual was not on ART above 200 copies/ml in blood and the VL in other uncontrolled transmissible fluids could have been even higher. (1)

Its simple there is nearly 22+ years of evidence on TaSP both through observational data and controlled studies, that consistently has proven its effectiveness confirming the Swiss statement and later the refined consensus statement, although the news/media act as if its something new.

There have been 0 sexual transmission recorded when someone living with HIV was and remained adherent to treatment for 6+ months and virally suppressed defined as lower than 200 copies . There have been transmission when people did not meet that statement/criteria . (2)

Hence based on records & studies at the time the Swiss statement was made  more than a decade ago (3) and, since then more large scale studies continued to confirm this and future refine that statement leading to empowering the U=U movement & supported consensus statement.

Now the scientific part of my brain says it not a never statement, although with the 22+ years of data and evidence behind it if it does ever go amiss in the future than we will all know about it as the one famous exception that otherwise simply confirms the rule.

Anyhoo, the reason i felt safe during my hypersexual manic episode..to go unprotected was because I'd come to the conclusions that you guys have presented to me.. that U=U. And how my Truvada itself can act as Prep from acquiring other strains.. glad to know my assumptions are accurate..

My normal cd4 is above 1000.. is why i freaked at it dipping so low in my recent bloodwork..

Happy to confirm the understanding of TaSP/U=U and I really hope the future treats you well and, you are able to have the surgery needed

Take it easy

Jim


(1)
Castilla J et al. Effectiveness of highly active antiretroviral therapy in reducing heterosexual transmission of HIV. J Acquir Immune Defic Syndr 40: 96-101, 2005

(2)
http://i-base.info/htb/32308

(3)
Vernazza P et al. Bulletin des médecins suisses 89 (5), 30 January 2008

[RoseMary]

Thanks Jim. Appreciate your response.

From here on out, I'll be sure to bookmark and share any studies that I mention, to avoid any misunderstandings. That wasn't my intention, so I apologize.

[leatherman]

to go unprotected was because I'd come to the conclusions that you guys have presented to me.. that U=U.

one other thing I noticed that we forgot to mention here (although Jim alluded to it) is that while HIV transmission to-or-from you was not an issue in this incident, the contraction of an STI was an issue. We think about safer sex stopping HIV but often forget that safer sex is also about stopping STIs. While HIV wasn't an issue from your UD unprotected sex, the chance of contracting an STI (syphilis, gonorrhea, chlamydia) was an issue. If you're still having symptoms, you need to bring STIs up with your doctor.

That wasn't my intention, so I apologize.

nothing to apologize for.  You posted here about an issue/fear/concern and got some information to help you understand that there was nothing to worry about. 

IMHO, the people who should apologize (if anyone needs to apologize that is ) are your doctor and the staff who in nearly a decade of treating you for HIV never adequately explained to you TasP, U=U, PreP, STI risk, or the meaning of cd4 counts.