HIV Reinfection and Superinfection

Drug Resistance Can Be Passed Along With the Virus

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It is not usual for couples to ask if they really need to use condoms if both partners have HIV. After all, what can harm can there be if they both have the virus, right?

As reasonable as the question may seem, there are potential consequences even among the most monogamous couples. Chief among these is reinfection.

As a communicable virus, HIV has the ability to mutate as it is exposed to different drugs. Each time that it is, it becomes its own unique virus with different types and degrees of drug resistance. As such, it is possible that one partner can infect the other with an entirely different variant of the virus and, by doing so, transmit the resistance along with the virus.

While this is less likely to happen if both partners are on antiretroviral therapy, there is still a chance if one or the other partner, for any reason, does not have a fully undetectable viral load. If this is the case, the acquired resistance can cause your drugs to work less effectively or even fail.

Understanding HIV Drug Resistance

HIV is not one type of virus. It is comprised of a multitude of different strains and variants. Moreover, if infected, you don't live with just one variant. Your genetic pool may have tens of thousands of different variants, some of which are more resistant than others.

Every time you are exposed to new medications, the virus pool will change and mutate. Those viruses able to resist the drugs will begin to thrive and eventually predominate. When the drugs are no longer able to stop the resistant viruses from multiplying, treatment failure occurs.

When this happens, not only will one or two drugs be affected. In many cases, entire classes of drugs will be lost, diminishing a person's future treatment options. In rare cases, superinfection can occur whereby a virus may be resistant to all currently available drugs.

Preventing Reinfection

In a relationship, if one or both of you are HIV-positive, consistent condom use should be the rule. While condoms are not 100 percent foolproof, they remain the best first-line defense against HIV.

If an accidental exposure occurs for any reason, don't panic. If both of you are undetectable, your risk of reinfection may not be zero, but it will be pretty close to that. On the other hand, if you are not adherent to treatment or haven't seen your doctor for a while, your risk will increase significantly.

If reinfection occurs, you may not even know it. Some people may develop mild, flu-like symptoms, while others will only know there is a problem when their viral load suddenly shoots up.

If treatment failure is declared, you will be given genetic tests to assess which drugs you are resistant to and to determine the combinations of drugs best suited for your virus. With improved adherence to therapy and avoidance of reinfection, there is no reason your HIV drugs shouldn't last a good decade or more.

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Article Sources
  • Blish, C.; Dogon, O.; Jaoko, W. et al. "Cellular immune responses and susceptibility to HIV-1 superinfection: a case-control study." AIDS. 2011; 26(5) 643–6. DOI: 10.1097/QAD.0b013e3283509a0b.

  • Redd, A.; Quinn, T.; and Tobian, A. "Frequency and Implications of HIV Superinfection." Lancet Infect Dis. 2013; 13(7):622-28. DOI: 10.1016/S1473-3099(13)70066-5.