Jun 6, 2001
Dear Dr Little
I understand that the only defensible advice for avoiding the transmission of drug resistance is to practise safe sex, and I am not trying to be provocative here.
I was wondering if the transmission of drug resistance is theoretically more problematic if the two parties are taking the same or entirely different drug combinations, assuming that the two parties are perfectly adherent and not infected with resistant strains to begin with.
Thank you, Keith
Response from Dr. Little
Actually - good question, but we don't know. We in fact don't know a great deal about what determines which virus is transmitted following a sexual exposure. That is, there are cases in which the source partner (the one who is already infected) is infected with drug resistant virus and yet their sexual partner (who becomes infected), gets infected with drug sensitive virus. In contrast, sometimes it is the drug resistant virus that is transmitted. It is also a real concern that if both sexual partners are HIV positive and one is infected with a drug resistant variant (person A) and the other is not (person B), that the drug resistant variant could be passed from person A to B and result in superinfection (or reinfection) of person B resulting in a change in their response to therapy. It is because we do not know the answers to these questions that the medical community is so broad in its recommendation to practice safe sex.
These questions are also complicated by the fact that the exact same virus may behave very differently in one person compared to another. That is, just because person A and person B are taking the same therapy, the acquision of another virus might result in more immune suppression (ie a drop in CD4 cells) in one person than the other - hence reinfection could still be bad, despite the fact that both viruses carry the same drug resistance mutations.
Food for thought...mild HIV ?
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