Poz taking AIDS cum

[mashimaro]

I'm having trouble finding anything about this. I have read that poz on poz can cause an infection of a new strain. So what exactly happens if i take an AIDS load?

[fillmyholeftl]

too many variables to give you an answer...IMHO, know your status, stay informed, take care of your health & make a rational decision for yourself.

[bearbandit]

Ideally what happens is that the local strain takes over. It's rare for a, say FTC-resistant strain, to take over from a local strain that isn't FTC-resistent. What doesn't happen is that you create a new superstrain of HIV.

I knew we were marching into trouble when we seperated HIV disease into asymptomatic, persistent generalised lymphandenothapy, aids-related complex and finally aids. In the UK we use degrees of HIV disease to reflect the changeability of the illness. Some of those categorisations are permanent (such as my osteoepenia), others, change (like when I had cryptosporidiosis five years ago or so). I fully understand the US's definition of aids is a political, rather than a medical, decision, to advance people who need it through the welfare system. The downside of the UK system is that you can recover and relapse - saves on the welfare bills! Two different solutions, from two different eras, to the same problem.

I can only speak for myself: I don't want to get sick again, but I regard HIV as the least of the things I could pick up with a man up my ass (y'never know - I might pick him up as well!)

[MackyJay]

I just love bearbandit's replies on almost any subject. Good work guy! So many that reply seem to have no clue, but your answers always seem to be well researched, logical, and basically extremely good advice. The only other one that comes close is the owner of this site Mr. Raw Top himself. Both do your homework and more guys need to before answering with things like, just take it and don't question, or other fairly ridiculous answers. I, myself, am not actively chasing, but on the other hand, I only BB, so being a good little realist, I know it is probably only a matter of time. Have had about 8 or 9 poz undetectable loads in me (the last one being last April) but have not had any 'known' unmedicated loads. I am also one of 'those' twins, Gemini, LOL, and mine falls into a romantic realist. LOL Makes for lots of conflict. LMBO Take care guys and don't ever change.

[Guest JizzDumpWI]

MackyJay, if you want to be a "good little realist", what keeps you from taking PrEP which would eliminate that "only a matter of time" component?

[mashimaro]

I agree mackyjay. that was a very thorough response bearbandit and thanks for taking the time! Though "local strain" as in, in my body local, or in the other guy local?

[bearbandit]

Sorry, my stupidity: I meant of course the strain local to the body it's in (you can tell I spent the weekend at an HIV conference!). In the early eighties safer sex (in London) meant not fucking with Americans, then after a while safer sex came to mean not fucking with Londoners, simply because we'd been exposed to this infectious agent. For what it's worth, I believe my virus goes back to SF. Then the condoms arrived. As drugs have developed so have resistances to those drugs, though most remain resistance-free, but it's important to remember that that HIV always seems to revert to wild type virus as resistant virus has .

We end up with with small local pockets where guys are first infected with a strain that has some resistance to one drug or another. It's rare but it does happen. Eventually, their virus reverts to "the ideal", the virus that doesn't understand the blocks medication puts in its way. It's long enough since I took nevirapine that I could probably take it again as the virus that became resistant to nevirapine should have died out by now.

Travel is too wide-spread to account for a local, geographical, strain: you have to start taking into account the local "within this body" strain, which also looks at the genetics of the person involved. Abacavir, to which my virus is supremely vulnerable would, it turns out, also kill me.

[rawTOP]

I'm having trouble finding anything about this. I have read that poz on poz can cause an infection of a new strain. So what exactly happens if i take an AIDS load?

BearBandit's answer was thorough, but the simple answer is that when a poz guy takes a poz load most of the time his original strain of HIV and the meds he's taking will fight it off, but every now and then the new strain can win and the guy has to change meds.

I vaguely remember hearing of one study that said that poz guys who took loads from other poz guys actually had lower viral loads. I think it was a study of poz couples. The theory was that constantly being challenged with helped the local strain and the body fight off new strains. Maybe someone else will recall that study more clearly than me.

[mashimaro]

Hm, I guess my research into the virus wasn't as thorough as I thought since this is all new to me. I guess I am part of that rarity that happened because my strain is resistant to Sustiva. The fact that the strain may revert back to ideal is good news, just so I have another option in the future. Unless of course, I misunderstood.

Maybe that's what the articles I read meant by "super infection." The fact that the new strain may win and a change of medication is necessary. My ID doctor didn't know what I was talking about when I mentioned it.

[bearbandit]

It's not unknown for guys to "inherit" their giver(s)' resistance when they get infected in the first place. Equally it's not uncommon for that resistance to disappear, hence the ability to "recycle" drugs after a few years. The rule is that the virus will always, over time, revert to "wild type" virus. Being resistant to Sustiva is a mixed blessing: on the one hand it has pretty much the best record for getting the viral load down to undetectable in the shortest time. On the other hand, two of its constituent drugs, efavirenz and tenofovir have amongst the worst side effect records.

Efavirenz can affect the central nervous system - a friend used to call it "free acid" while I know of a a number of doctor who will not prescribe it if their profession lives involve any sort of concentration. Tenofovir (I admit my bias!) can cause severe kidney damage and osteopenia (thinning of the bones). Left unattended to for long enough it can kill.

It's rare to get a strain of HIV that's resistant to more than one drug, if any. Super-infection refers to already having one strain of HIV and then getting another: last time I talked to the health advisor where I work (an HIV charity) super-infection was happening at a rate of about once per year in the entire world. It really is that rare.

My thoughts on what's happened is that you've picked up HIV from someone who's become resistant to one of the three antiviral components of sustiva. You say "this is new to me" so I guess that sustiva is your first antiretroviral (ARV). The only way to sort out which of the three drugs you're resistant to is to split them into their separate components, and try you for some months on two, plus another, then swap one of the the sustiva drugs for another.... You see where I'm going?

It would be a damn sight easier just to make a note on your records that TFC, tenovir or efavirenz don't fit. The trouble is that we're going to see a lot of promotion of efavirenz as, psychedelic side effects aside, it's one of the most effective drugs at lowering the viral load fast and it's about to go out of patent, which makes for a massive price reduction.

[mashimaro]

I knew about the kidney damage of Tenofovir, considering it is part of my cocktail. I'm on Stribild currently.

I'm glad that super-infections are really rare, I didn't want to become paranoid about another thing.

What I meant by "this is new to me" is the information you're providing. Stribild was the first drug that I am on, I have a habit of liking the newer things, lol so I chose it over Complera. Oh I found the resistances of my strain from the lab work.

For some reason I feel there's something that's going over my head from reading your posts but I'm not sure what..

[bearbandit]

You're getting the truth as I know it from me: I'm already on salvage therapy - where they patch together the best therapy they can from that you're not allergic/resistant to. My being known as the local drugs whore at "work" refers only to the fact that I have greater experience than anyone else of prescribed ARVs: last time I took something illegal was over ten years ago when I rubbed some charlie on my gum to call a halt to the to toothache I was enduring. May I recommend www.aidsmap.com or www.tht.org.uk for information in further detail?

[Poz1956]

Just to clear something up here - Sustiva is brand name of the single drug Efavirenz. It is not a multi-drug combination therapy, and does not contain Tenofovir

I believe Super Infection can be either a second infection with one of other the HIV-1 Sub-types (A through K), or with HIV-2. In the western world pretty much all us Pozzies have HIV-1 Sub-type B.

I have seen a report that female sex workers in subsaharan Africa, that were co-infected with a second sub-type. They did exhibit a higher immune response to that second virus. But I'm pretty sure I've read something else where multi-sub-type infected people did not do as well. It may well depend on what combination of sub-types they were exposed to.

It sounds as though the OP may have had genotyping performed on his blood samples, and the Efavirenz resistance showed up in that. Genotyping determines what ARV combo your particular virus is most susceptible to (or in Bear's case probably least resistant to). It seems to have become common before starting on ARVs, as opposed to the old way, of trying one combo for a few month, and and taking the "wait and see" approach on how the CD4 and viral load reacts. It probably preservers more options for treatment later on, should they become necessary.

There has been much flailing of arms, and wringing of hands from the medical establishment that Poz on Poz BB would lead to Super Infection with multi-drug resistant strains. It's just has not really turned out to be happening that way.

Though they are seeing newly diagnosed at risk youth with resistance to at least one ARV (similar to the OP's resistance to Sustiva). While the population samples are too small to make a real determination, it's theorized that they caught HIV from older men, with long treatment histories. For example IF someone caught HIV from Bear (calm down - an example - not a finger pointing), they could inherit the drug resistances that Bear has. However they wouldn't necessarily have same intolerance to drugs that Bear just can't stomach. (Only about 5% of people are allergic to Abacavir, and perhaps that person's tummy can handle something that makes Bear barf till his stomach turns inside out.)

I think I just got way too technical, and did a TMI thing. That happens to me when I've been sitting all night at the computer. Get on a roll, and can't stop typing.

[bearbandit]

Just to clear something up here - Sustiva is brand name of the single drug Efavirenz. It is not a multi-drug combination therapy, and does not contain Tenofovir

You're quite right - my mistake entirely as I was thinking "Atripla". My excuse is that I sometimes get confused between pharmaceutical names and "public" names. I'd simply forgotten the name Sustiva as I always refer to it (as to most in the UK as efavirenz. My apologies for the confusion.

It sounds as though the OP may have had genotyping performed on his blood samples, and the Efavirenz resistance showed up in that. Genotyping determines what ARV combo your particular virus is most susceptible to (or in Bear's case probably least resistant to). It seems to have become common before starting on ARVs, as opposed to the old way, of trying one combo for a few month, and and taking the "wait and see" approach on how the CD4 and viral load reacts. It probably preservers more options for treatment later on, should they become necessary.

It's getting more and more common to genotype before prescribing in the UK. Important to note that genotyping requires a viral load of at least 1000, so that when I blipped last year and became briefly detectable, there was nothing to be done except carry on as before and genotype should my VL get to 1000. That's when it went down to 0.

There has been much flailing of arms, and wringing of hands from the medical establishment that Poz on Poz BB would lead to Super Infection with multi-drug resistant strains. It's just has not really turned out to be happening that way.

For some time now the view in the UK has been "ok, go ahead, but just don't shout about it". The official position is still that neither PrEP nor TasP are sufficient. The final weapon they use is "but what about all those other STIs that condoms protect against?" In the seventies it was standard advice that if you were sexually active then you should have a checkup at least every three months. It was as much a part of gay life as the risk of getting arrested for looking at another guy's dick in a public toilet.

Though they are seeing newly diagnosed at risk youth with resistance to at least one ARV (similar to the OP's resistance to Sustiva). While the population samples are too small to make a real determination, it's theorized that they caught HIV from older men, with long treatment histories. For example IF someone caught HIV from Bear (calm down - an example - not a finger pointing), they could inherit the drug resistances that Bear has. However they wouldn't necessarily have same intolerance to drugs that Bear just can't stomach. (Only about 5% of people are allergic to Abacavir, and perhaps that person's tummy can handle something that makes Bear barf till his stomach turns inside out.)

What's been noted in the UK is clusters of resistant virus, where, as I think you correctly theorise, someone has picked up HIV from someone with a drug resistance, and then that resistant virus has been passed around.

Calm down? Who's annoyed? I'm comfortable with my long and varied drug career: just a little cagey about what the next step is should the current combination fail. I think too much emphasis (despite what I say about tenofovir - I'm allowed a little hypocrisy surely) is placed on side effects, though you're right about different people reacting differently. When ritonavir was first introduced a friend got such bad pain from it that he was prescribed morphine. I just got diabetes: know which I'd rather have had

Tolerance of abacavir varies. This from Wikipedia: "There is an association between the prevalence of HLA-B*5701 (my words: the gene responsible for abacavir sensitivity) and ancestry. The prevalence of the allele is estimated to be 3.4 to 5.8% on average in populations of European ancestry, 17.6% in Indian Americans, 3.0% in Hispanic Americans, and 1.2% in Chinese Americans. There is significant variability in the prevalence of HLA-B*5701 among African populations. In African Americans, the prevalence is estimated to be 1.0% on average, 0% in the Yoruba from Nigeria, 3.3% in the Luhya from Kenya, and 13.6% in the Masai from Kenya, although the average values are derived from highly variable frequencies within sample groups."

For the past ten years it has been pretty much automatic to test for HLA-B*5701 before prescribing abacavir. I sat in the doctor's office in 2004/5 while he decided he might as well order a genetic assay before changing my combination. Just as well he did...

I think I just got way too technical, and did a TMI thing. That happens to me when I've been sitting all night at the computer. Get on a roll, and can't stop typing.

One TMI deserves another

[Poz1956]

My fear wasn't offending you Bear - I knew you'd understand what I was saying. I was half expected someone to jump to your defence, being certain I had besmirched your honour, and saying "Bear only plays with Poz people. He would never pass it on."

The head of the HIV clinic here has referred to Ritonavir as "one of the most Puke-A-Genic substances on earth." That was certainly my experience. At random times the slightest smell, or even sight of some foods and other stuff would have me retching. I'd wander the grocery store for hours trying to find something I was even the slightest bit interested in eating.

And I guess I have to make a correction to my use of "geneotyping." Phenotyping is drug susceptibility testing. In it physical samples of blood from a patient, are spiked with individual ARV drugs, and notes are taken about how much (or how little) virus is killed. They test samples against all ARVs, thus allowing a doctor to pick the best combination for that particular patient.

Genotyping looks at the genetic sequence of the RNA in the virus. It can be compared to a known database for drug resistance. But is rarely used that way. It is also used to compare the virus between different people. If the genetic sequence has very few mutations, there is a very high probability that one transmitted the virus to the other, or that both of their viruses were sired by the same third person.

Edited March 15, 2014 by Poz1956