Help With a Serodiscordant Relationship

[sftony]

Hello everyone, I'm new here so please forgive me if this is in the wrong place/includes some misconceptions or misunderstandings.

I recently started seeing someone who is positive: I am negative, and we are a gay couple. Prior to meeting this person, whom I find to be an absolutely amazing person and in many ways my kindred spirit (and I know he feels the same way), I harbored a lot of irrational fear and misconceptions about dating/being in a relationship with an HIV+ person. Having this person in my life has really helped me grow as a person, and I feel like I've put all of the irrational fear behind me, but now I'd like to know more about what to expect and learn how to be a supportive partner.

On the sexual safety side of things, I've been doing lots of research and based on recent findings from the PARTNER mid-point analysis, The Swiss Statement, and other surveys of serodiscordant couples, it seems like a viral load below 200/mL makes transmission to a spouse/partner extremely unlikely and 20/mL or below almost impossible, if not impossible. I would like to know if there is more info I haven't yet found or if there is more I should know about this.

I do have an appointment this month with an HIV specialist to discuss options such as PrEP; what are some things in your experience that are helpful to know/ask about PrEP or serodiscordancy that isn't widely published or known? Also, what are the implications of PrEP being used when the positive partner is also taking Complera? My understanding is that Complera and currently approved PrEP share 2/3 drugs; does this mean that if my partner were to develop treatment failure, the chances are higher that it would be a truvada-resistant strain? 

Finally, how does one help the positive partner with the emotional aspects of being a modern HIV patient? My boyfriend has encountered a lot of dreadful treatment when he's told dates/dating prospects. He told me that since he became positive every person he's tried to date has left the moment they found out (except for me), and that drove him to suppress feelings about being positive. He's going to start therapy to help with some of these issues, but I can't help but feel guilty myself. Prior to meeting him, I'm sure I contributed to that stigma he felt in some way; now I worry excessively about his health, both physical and emotional. What are some things that other serodiscordant couples have found helpful? I think his feelings are perfectly appropriate given what's happened to him, but it haunts me to think how much pain he's in. Do I just have to let him heal on his own and simply be there for him? That seems intuitively correct, but also makes me feel like I'm not doing enough for him, though to be honest, I feel like until I personally find a cure, I wouldn't have done enough. 

Thanks for any insight and help you might have.

[CaveyUK]

Sounds like you are up to speed with everything you have said. Nothing really to add.

Not sure I understand the complera question. If he is on effective treatment and UD, and you are on PrEP then you really don't need to worry about 'Truvada resistance'. As you will know from recent news, there has only been one confirmed case of transmission whilst on PrEP (which both of you will be on, effectively). Just one single confirmed case. So rare you needn't concern yourself with it.

And that microscopic-risk assumes he is out having bareback sex with multiple partners outside the relationship.

The only thing I would add is a reminder that PrEP does not shield you (or him) from other STI's, in many cases STI's that are trickier to treat than HIV.

As for your approach to support. It is the same as it would be with anyone with a chronic medical condition. Offer support but don't crowd him or be over-bearing. Allow him to process living with the virus in the way he see's fit, but ensure he knows you are there if you need him for anything.

Being well read and up to speed is a great thing to be though, so it all bodes well!

[harleymc]

Hi Tony
welcome.
It sounds like both of you are really wanting to make a go of this.

You've done your homework rather well. There's no 'lesser known' stuff out there that you haven't discovered.

On the issue of the overlap between Truvada and Complera.
For PreP there's no alternative medication to Truvada. I'm not a Dr so I can't advise whether or not Truvada would give you any protection in the scenario of your  partner's as yet hypothetical treatment failure. Ask the Dr about this when you see him or her.

Complera has Rilpivirine in it (the ingredient that requires a meal, and creates many of the drug interaction warnings). Rilpivirine has a long half life in the body so Complera gives great protection against treatments failure even when dosing might be a little irregular in timing.

Whether or not this relationship becomes the one great love, I wish you well.
Hugs from Australia

[EUINAU]

I loved your post, it seems like you have your head screwed on correctly

I have been infected and diagnosed 3years ago. I was in a relationship with a partner who was negative. I didn't develop any issues accepting my diagnosis as I had amazing nurse and doctor at our HIV clinic the moment I was told I might be Poz and they explained to me that it isn't a death sentence anymore.

I have mostly been in relationships and lived in countries where homosexuality was illegal and HIV wasn't something people would talk about and I didn't really know anything about HIV. I would say I was very ignorant and I didn't know anyone positive.

My partners constant mothering and asking me if i took my "vitamins" drove me a bit crazy to be honest. He also probably could not understand why I wasn't expressing any concerns.

He wanted to have unprotected sex which at the time I refused as we were at that point more like room mates and there wasn't great deal of love between us so I insisted on using condoms, which led to us not having sex at all towards the end.

Cut the story short I would say that you both should discuss what each other likes, dislikes and appreciate and listen to each other's needs. If you do that you will be able to support each other and avoid any resistance or unnecessary issues.

Self love is important and I understand how your partner feels although I must say I have been very lucky as I lived my first 7 months as a single hiv poz man in France and people I met in France surprised me with their acceptance. Most guys bar 2 didn't blink, knowing we were using condoms and on top of that me being UD.

I actually dated couple of younger negative guys who didn't really care about my status as I suppose the education in France among gay community is very good in this regard.

So love yourself first - this goes for both of you, ensure you communicate openly and
keep smiling and loving each other

[sftony]

Thank you everyone for the very kind and thoughtful replies.

Not sure I understand the complera question. If he is on effective treatment and UD, and you are on PrEP then you really don't need to worry about 'Truvada resistance'.

On the issue of the overlap between Truvada and Complera.
For PreP there's no alternative medication to Truvada. I'm not a Dr so I can't advise whether or not Truvada would give you any protection in the scenario of your  partner's as yet hypothetical treatment failure. Ask the Dr about this when you see him or her.

I realize I used the words "treatment failure" incorrectly. I am not at all worried about him missing any doses; he's very responsible and prompt by nature. I guess what I was trying to ask was how often/rarely Complera, or now Odefsey as the successor combo, will cause drug resistance to emerge in a person who is otherwise healthy and UD. I will of course be asking the doctor(s) to provide more info on this, but from what I've seen so far, many members of the positive community and their loved ones know a great deal about the various factors at work, so I was sort of looking for the "lay expert" opinion, as it were :p. 

The only thing I would add is a reminder that PrEP does not shield you (or him) from other STI's, in many cases STI's that are trickier to treat than HIV.

Oh most definitely. We are not taking any chances just because the "the big one" has been addressed. I just completed a full STI panel and he will have one done soon as well, but until then condoms are still in use. 

I actually dated couple of younger negative guys who didn't really care about my status as I suppose the education in France among gay community is very good in this regard.

I'll be honest, I learned most of my base knowledge about HIV at a time when the diagnosis was still brutal (pre-HAART). Until this man came into my life, I knew that lifespans were essentially normal and modern drugs much safer, but I had absolutely no idea that serodiscordancy was possible without condoms. Every public message concerning HIV never communicates to people that serodiscordancy is not only possible, but if the PARTNER study is confirmed in Phase II in 2017, statistically speaking serodiscordancy carries a lower risk of acquiring HIV for the negative partner. To someone like me who grew up at the peak of fear and panic, that is simply astounding. It's an incredible change compared to what I was taught, so I can certainly see how it might be easier for someone who is younger and learned their baseline knowledge at a time when HAART was already in use.

So love yourself first - this goes for both of you, ensure you communicate openly and
keep smiling and loving each other

We still make each other laugh every day.

[harleymc]

Remember I'm not a doctor... just been living with this stuff as an advocate for 30+ years - the science keeps shifting subltly but we know more and more all the time
Your partner isn't going to have a failure in his treatment if he's doing as per prescription.
I know this stuff is a lot to take on. Your learning curve is so immediate, so fast.

I was on the other side of the equation recently with a negative partner, whether or not Prep would have been appropriate, he didn't want to educate himself about prep. I'm certain you'll be fine. These doubts might be good to share with your man with a counselor, certainly you need to air them, just not make them an ongoing theme. Love  is the ongoing theme!

Second Hugs from downunder
(does the mean we're like dating or something?)

[sftony]

I know this stuff is a lot to take on. Your learning curve is so immediate, so fast.

It sure is! I feel like I had to throw out almost everything I knew and start from scratch! I can't emphasize enough how helpful resources like this forum have been.

I was on the other side of the equation recently with a negative partner, whether or not Prep would have been appropriate, he didn't want to educate himself about prep. I'm certain you'll be fine. These doubts might be good to share with your man with a counselor, certainly you need to air them, just not make them an ongoing theme. Love  is the ongoing theme!

Indeed. I've been very informed about PrEP even before meeting this man, and my hesitation around it was primarily related to efficacy and side effect safety, both of which have been fairly robustly answered in follow-up studies since it became approved in the US. I'll admit, it does feel a bit strange to me to take a drug every day to prevent a medical condition, but as it is functionally a vaccine at this point in time, I won't continue to resist its obvious advantages. That is one good thing to come about from this experience, even if we as a couple don't work out: I was forced to confront the very changed landscape rather than try to avoid it. 

Second Hugs from downunder
(does the mean we're like dating or something?)

Aussie hugs are the best! (also, totally-third hug means we gotta to pick out some colors  )

[CaveyUK]

it does feel a bit strange to me to take a drug every day to prevent a medical condition

Oh, I don't know. Many people take pills to prevent heart problems. Or vitamins to warn off colds. I spend each summer taking one-a-day antihistamines as otherwise my life is a misery with hayfever. We plaster sunscreen on ourselves in the sun to avoid sunburn and we vaccinate ourselves against a variety of things.

Not quite as strange as it first appears

[EUINAU]

Oh I am Aussie too

[tednlou2]

Welcome to the forums.  Congrats on the relationship.  And it's great you've educated yourself so well.

I read Dr. Gallant's tumblr q&a site.  He's a well known HIV doc and researcher.  I bet you've heard of him.  When asked about a neg partner using PrEP when the poz partner has consistently been UD, he always says it is overkill.  He always says if it will give you better peace of mind, then he thinks it's good. 

My partner is neg.  I wish you two all the best.

Ted

[sftony]

Oh, I don't know. Many people take pills to prevent heart problems. Or vitamins to warn off colds. I spend each summer taking one-a-day antihistamines as otherwise my life is a misery with hayfever. We plaster sunscreen on ourselves in the sun to avoid sunburn and we vaccinate ourselves against a variety of things.

Not quite as strange as it first appears

I suppose you're right, so maybe it's more accurate to say that it feels a bit early to be taking a daily drug for prevention purposes (I'm in perfect health and I think psychologically vaccines are a tad different). And, I did used to take allergy medications almost daily before getting allergy shot therapy so your point is very well taken; I highly recommend the shots if available in your area.

Welcome to the forums.  Congrats on the relationship.  And it's great you've educated yourself so well.

I read Dr. Gallant's tumblr q&a site.  He's a well known HIV doc and researcher.  I bet you've heard of him.  When asked about a neg partner using PrEP when the poz partner has consistently been UD, he always says it is overkill.  He always says if it will give you better peace of mind, then he thinks it's good. 

My partner is neg.  I wish you two all the best.

Ted

Yes I have read some of his work before, and I must say it was my initial reaction as well after PARTNER I was published and the Swiss Statement went 7 years (and counting) without a single contrarian instance. By my estimation, PrEP would be an added level of safety (mostly psychological) early in the relationship while also providing some minor insurance against unexpected high blips or the like. I am also fairly confident that a highly efficacious vaccine will be available within the next decade or so (smart money says Dr. Gallo's GP120 vaccine will be the winner, as it's been carefully refined over a 15+ year period), but until then an added measure of precaution doesn't seem too unreasonable so long as I don't suffer any of the rare and extreme side effects. I'm sure that if things keep going well and PARTNER II confirms PARTNER I, we will likely revisit the issue together and decide what's best; I feel like it must be a team decision as I wouldn't want him to ever be afraid of intimacy on account of my unilateral decision to halt PrEP.

Oh I am Aussie too

  Just where were you all of you fine men when I was young, single, and suggestible? Oh right, probably living the good life down under!