Is It Possible to Get Reinfected If You Have HIV?

Even in the Age of PrEP, Safer Sex Is Still Important

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Without doubt, one of the most commonly heard questions by HIV specialists, counselors and clinics alike is: "My partner and I are both HIV positive. Do we still need to use condoms?"

And with the rise of newer preventive technologies, including HIV pre-exposure prophylaxis (PrEP) and HIV treatment as prevention (TasP), the question is likely be asked even more, particularly as  couples grow increasingly weary of having to use condoms (a condition commonly referred to as "condom fatigue.")

Despite these advances, the most responsible answer to the question is "yes".

For years HIV reinfection (or superinfection as it is sometimes called) has been a consequence of condom-less sexual encounters between two HIV infected people. Simply put, reinfection occurs when a person with HIV gets infected with a different viral strain through sexual contact (or shared needle use) with another HIV-infected person.

The consequence of reinfection is that the new viral strain may have genetic mutations that are resistant to the drugs you are taking. This is commonly referred to as having an acquired (or transmitted) resistance. When this happens, your drugs can start fail you, with a return of viral activity, after which you may be forced to change your therapy, reducing the number of future treatment options.

How Does Reinfection Affect Me?

HIV is not one type of virus; it is made of many different mutated strains, some of which confer to high levels of drug resistance.

When exposed to medications, this HIV population changes and those mutations able to resist the virus begin to thrive. In time, they will become the dominant strain, manifesting with higher levels of drug resistance and finally treatment failure.

If a person is reinfected with a strain of HIV that increases levels of drug resistance, treatment will be much more complex, and will often affect not only one drug but an entire class of drugs.

What Should I Do to Prevent Reinfection?

In a relationship, if one or both of you are HIV-positive, consistent condom use should be the rule if ever engaging is sexual contact. While condoms themselves are not 100% foolproof, particularly if used improperly or inconsistently, they remain the best first-line defense.

If an exposure has occurred, advise your doctor about this if you or your partner suddenly find your viral load increasing. You doctor may suggest performing a genetic resistance test if your treatment appears to be failing, the test of which will indicate what type of HIV resistant mutations you have developed.

Additionally, partners can reduce the risk of reinfection by ensuring that (a) each HIV-infection partner is on antiretroviral therapy and (b) each partner's viral load is undetectable. In short, the less virus that a person has in his or her blood, the less virus there are to infect (or reinfect) others. This is a preventive strategy commonly referred to as treatment as prevention (or TasP).

In addition, if only one partner has HIV, the other can opt to take HIV pre-exposure prophylaxis (PrEP), a daily antiretroviral tablet which can reduce the risk of acquiring HIV from anywhere from 70-90%. Currently, PrEP is recommended for sexually active men who have sex with men (MSM), injecting drug users (IDUs), mixed-status (serodiscordant ) heterosexual couples, or any person at high risk of acquiring HIV.

Sources:

U.S. Centers for Disease Control and Prevention (CDC). "Interim guidance for health-care providers electing to provide preexposure prophylaxis (PrEP) for the prevention of HIV infection in adult men who have sex with men and who are at high risk for sexual acquisition of HIV." Morbidity and Mortality Weekly Report (MMWR). January 28, 2011; 60(03):65-68.

U.S. Centers for Disease Control and Prevention (CDC). "Interim Guidance for Clinicians Considering the Use of Preexposure Prophylaxis for the Prevention of HIV Infection in Heterosexually Active Adults." Morbidity and Mortality Weekly Report (MMWR). August 10, 2012; 61(31):586-589.

U.S. Centers for Disease Control and Prevention (CDC). "Update to Interim Guidance for Preexposure Prophylaxis (PrEP) for the Prevention of HIV Infection: PrEP for Injecting Drug Users." Morbidity and Mortality Weekly Report (MMWR). July 14, 2013; 62(23):463-465.

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