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Lifestyle:

Wed 24 Aug, 2011
By Sam Bristowe

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Newly diagnosed? New questions?

Newly diagnosed? New questions?

Being diagnosed with HIV will leave you with many questions, so PN asked the i-Base website to look at the some of the things they are most frequently asked.


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Newly diagnosed? New questions?

Being diagnosed with HIV will leave you with many questions, so PN asked the i-Base website to look at the some of the things they are most frequently asked.

The website (www.i-Base.info) includes an online Q&A service where you can email questions that will be answered online or emailed back to you privately. There are now over 800 online questions and answers that cover a wide range of subjects, including questions asked by those newly diagnosed.

Question: Could I have picked up a different strain of HIV?

I was infected approximately in year 2000.

I was diagnosed in 2008. Between these years, could I have picked up different strains of HIV from different partners? Or, perhaps, created my own strain of HIV?

Answer: If you had unprotected sex with other HIV-positive partners during those years, then there is a chance that you could have been reinfected with a different strain of HIV. A small study from the UK reported in April, detected this in 2 out of 8 people studied. So this may be more common than people previously thought.
That is why it is important to have a genotype resistance test when you are diagnosed and before you start treatment. Most probably, your clinic has done that for you to avoid putting you on medicines that may not work for you, but it always worth checking.

Everyone develops many different strains of HIV. So although you were infected with one type of HIV, this is continually evolving while you are not on treatment. After several years you will have hundreds of slightly different variations. When you start treatment and get an undetectable virus load, any further viral evolution is stopped.

Q: My skin became darker, what can I do? I was diagnosed with HIV in March 2008 and my CD4 count was 70 and viral load was over 1 million. Now my CD4 count is 174 and viral load is undetectable. The problem is my face has become darker. Is this because of the medication or something else?

A: One study showed a low level of vitamin D may cause darker skin. Several other recent studies have reported low vitamin D levels in HIV-positive people. Checking this now could also pick up early problems with bone health. This is only one of the possible cause. If you discuss your concerns with your doctor, he/she may decide to do some further tests including referral to a skin specialist.

Q: How can I participate in a clinical trial? I have recently been diagnosed HIV-positive and I am happy to volunteer for therapy/drug trials. How do I go about this?

A: The best starting point is your hospital. Usually the hospitals in the larger cities are also research centres but if your clinic doesn’t run studies, you can participate in a trial in a different hospital. This may require, however, travelling to a larger hospital. Again, your doctor should be able to help you with this.
If your CD4 count is over 500 cells/mms then you could consider the SMART study that randomises people to either immediate treatment or waiting until the CD4 count reaches 350. This is likely to be one of the most important international studies for the next 5 years.

Q: I have infected my partner. What shall I do? Thinking it would be safe, I recently had unprotected sex outside of my relationship, and discovered soon after that I contracted HIV and then in turn infected my 23 year old partner.
I am older than him and so feel terribly guilty that his future will be affected now because of my weakness! What can help me let go of the guilt as I’m finding it difficult to live with myself?

A: I am really sorry to hear about you and your partners new diagnosis. While HIV changes everyone’s life, treatment now is better than it has ever been – and it will get better still. Many people take only one pill a day and the side effects are mild to moderate and there are alternative options if you have problems.

While you seem fairly confident that you caught HIV before your partner, it may be worth considering that it could be the other way round. This is something that tests will never be able to determine. I don’t know the details of your relationship, but this is not out of the question.

You did not know that you were going to get infected, so there was no intentional transmission on your side. Even being careful, accidents happen. It is probably better now to focus on how to move forward now, as it may pose some difficulties in the beginning.

For some people, going through difficult issues can make a relationship stronger, but specialist counselling for both you and your partner may make this easier, whatever the final outcome, and especially to deal with your feelings of guilt. This should be available from heath advisors at your clinic or through community HIV organisations.

Q: Is my virus at the point of eradication?
I got my blood work last week with my new result. My VL was 21. My question is, what is the meaning of this figure? Does it mean that my viral load is at the point of eradication?

A: Your result indicates a very low viral load, which will be considered ‘undetectable’ in almost all cases, apart from some very high-powered research, where ‘undetectable’ may mean getting below 10 or even less than 5 copies/mL.
Having undetectable viral load does not mean that HIV has been eradicated. It only means that the virus is well controlled. The only new virus you have is likely to be coming from sleeping CD4 cells (sometimes called resting, dormant or latently-infected cells), that wake up as part of their normal function.

The situation may differ in other part of the body, called ‘sanctuary sites’. These are places where the virus is stored and where ARVs may not be as effective.
Generally though, any viral load less than 50 copies/mL is great news and will lead to years of additional healthy life, so long as you are careful in taking your meds on time. PN

Q: Can I have unprotected sex with my partner if we are both HIV-positive and on treatment?
A: This is a question everyone asks, and the answer is a little complicated. What you decide in the end will be your personal decision on the risks and benefits.
The more you know about your partner’s health the more informed your decision.
At one extreme, if neither of you have drug resistance then the risk is negligible.
However, if one of you has multidrug resistance, then the consequences of reinfection are more serious. As with the risk of initial infection, viral load also plays an important role. If you are on treatment with an undetectable viral load the risk is much lower than when viral load is higher.

If you and your partner have the same resistance pattern (you should both already have results from a genotype resistance test in your notes), then the only risk comes from other sexually transmitted infections if either of you has other sexual partners where they do not use condoms.

Your partner will need to be adherent to treatment by not missing doses (so that neither of you develop new resistance).

Although this sound complicated, many HIV-positive people actively chose HIV-positive partners because this aspect of life is so important to them, and they can enjoy sex in a way that removes the risk of exposing their partner to HIV.
For others, catching HIV once was enough, and continuing to use condoms is just as easy and less stressful.

 

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