I thought you were on meds? Must have you confused with someone else.
Might be your Avatar confusing you, or twisting you.
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
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.
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.
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.
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.
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.
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
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
Funny, I actually thought about Occam's razor this morning when I was thinking about this.
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
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."
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?
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.
How about abstinence? That would also work.
But abstinence is no damned fun! :-\
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.
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
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.
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.
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.)
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?
Well couldn't one in theory be exposed to an HIV strain resistant to one's own HAART, and therefore be reinfected?
Well couldn't one in theory be exposed to an HIV strain resistant to one's own HAART, and therefore be reinfected?
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.)
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
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.
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
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? ??? :)
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.
you could obtain a virus with mutations that would render your medications useless.Ah! Now there's a reason I can understand. ;) ;D
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.
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.
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?
you wouldn't be so damn gung-ho to keep barebacking left and rightwho says I bareback? not I :P
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
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.
Which doctors?
MtD
(Who almost made a punz)
Dr.Gallant
So it's Doctor - the singular.
MtD
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.
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.
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).
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.
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.