Question

We are both HIV+ and stopped using condoms, what are the risks of reinfection?

26 April 2007. Related: All topics, HIV reinfection (superinfection), HIV transmission, Living with HIV long-term.

Me and my partner are both positive and we have stopped using condoms. What risks are there, if any? what are the chances of us becoming drug resistant?

Answer

Answer: Simon Collins

Thank you for posting your question and for allowing us to answer this online.

This is an important issue. It sometimes generates emotional responses and is a subject for ongoing research.

In practice, one of the benefits of having an HIV-positive partner is that you may want to stop using condoms, and for many people this is good and improves their quality of life.

Although HIV-positive people can be reinfected with a different type of HIV, the risk of this is probably lower that the risk of catching HIV when you were HIV-negative.

More importantly, the only impact that reinfection is likely to have on your long-term health, relates to catching a new type of HIV that is resistant to HIV drugs. This has been reported though, including a few cases where people on successful treatment have seen their treatment fail because the new infection was resistant to three classes of HIV drugs.

Every situation is individual. For many couples the risk would be zero (for example if you both have exactly the same virus already) and for others they would be much higher (if one partner was resistant to all treatment and had a high viral load, while the other had no resistance),

One study from San Francisco supporting the low risk comes from not finding cases of reinfection from about 20 couples followed for an average of two years, although many of these people were on treatment, which would have reduced any risk. Examples of where reinfection can be serious come largely from individual case reports.

Your individual treatment history is really important is looking at risk

If neither you or your partner have drug resistance, then the risk is zero.

If either of you has a history of drug resistance, then the risk is that this could be passed to your partner. The risk is probably much lower if you are both on treatment with undetectable viral loads, but it is worth considering that this could still be possible.

Your clinic should have tested you for resistance when you were first diagnosed, or when you started of changed treatment. If you are not on treatment, and didn’t get these results, then you can ask for this test now.

If any of your previous combinations failed (ie viral load rebounded while on treatment) then whether or not you had a resistance test, you could guess at the likelihood of resistance depending on the drugs you used and how high your viral load rebounded.

One other factor to consider, relates to whether you are monogomous or have an open relationship, as condoms protect against other sexually transmitted infections, including the rare chance of reinfection with drug-resistant HIV.

See also the answer to a similar question posted a few weeks ago.

I hope that the information here is helpful and that everything works out well for you together.