Re: NATAP: MSM Get Multiple HIV Viruses

[Guest guest]

Interesting article, but sooooo dense! Jules, what are the clinical implications of MSM having many virus variants? If someone's VL is below detectability and they continue to be on effective HAART, does acquisition of new HIV-1 variants pose a risk to viral suppression? Not in theory but as observed. Or do we lack sufficient data?

Thanks!

Jerome

In a message dated 5/15/2010 10:30:07 A.M. Eastern Daylight Time, JuLev@... writes:

"MSM were twice as likely as HSX subjects to become infected by more than one virus, with some MSM acquiring as many as 7 to 10 or more viruses....

[Guest guest]

Thats a good question, i dont know the answer but my guess is if a person has undetectable HIV it doesnt matter, it matters to the person who gets an initial infection with multiple viruses but its a good question, let me see if I can find out moreJulesSent from my Verizon Wireless BlackBerryFrom: solarjerom@...Date: Sat, 15 May 2010 12:17:07 EDT<JuLev@...>; < >Subject: Re: NATAP: MSM Get Multiple HIV VirusesInteresting article, but sooooo dense! Jules, what are the clinical implications of MSM having many virus variants? If someone's VL is below detectability and they continue to be on effective HAART, does acquisition of new HIV-1 variants pose a risk to viral suppression? Not in theory but as observed. Or do we lack sufficient data? Thanks! Jerome In a message dated 5/15/2010 10:30:07 A.M. Eastern Daylight Time, JuLev@... writes:"MSM were twice as likely as HSX subjects to become infected by more than one virus, with some MSM acquiring as many as 7 to 10 or more viruses....

[Guest guest]

Interesting article, but sooooo dense! Jules, what are the clinical implications of MSM having many virus variants? If someone's VL is below detectability and they continue to be on effective HAART, does acquisition of new HIV-1 variants pose a risk to viral suppression? Not in theory but as observed. Or do we lack sufficient data? I don't know of studies suggesting that MSM do worse on HAART than others, so in terms of current therapy, there may be little difference.The main problem would seem to be for designing of effective vaccines, yet another challenge for this seemingly very difficult goal.It does make you wonder about the issue of "re-infection," suggesting many MSM are already "superinfected."JB

[Guest guest]

I did a little investigating with one of thw study authors I know and it appears the answer to your question was he doesnKt know how a person with undectable VL would respond to getting infected with such a virus(s) but he siad it can't be good.Sent from my Verizon Wireless BlackBerryFrom: julev@...Date: Sun, 16 May 2010 09:26:45 +0000<solarjerom@...>; Poz lipo< >Subject: Re: NATAP: MSM Get Multiple HIV VirusesThats a good question, i dont know the answer but my guess is if a person has undetectable HIV it doesnt matter, it matters to the person who gets an initial infection with multiple viruses but its a good question, let me see if I can find out moreJulesSent from my Verizon Wireless BlackBerryFrom: solarjerom@...Date: Sat, 15 May 2010 12:17:07 EDT<JuLev@...>; < >Subject: Re: NATAP: MSM Get Multiple HIV VirusesInteresting article, but sooooo dense! Jules, what are the clinical implications of MSM having many virus variants? If someone's VL is below detectability and they continue to be on effective HAART, does acquisition of new HIV-1 variants pose a risk to viral suppression? Not in theory but as observed. Or do we lack sufficient data? Thanks! Jerome In a message dated 5/15/2010 10:30:07 A.M. Eastern Daylight Time, JuLev@... writes:"MSM were twice as likely as HSX subjects to become infected by more than one virus, with some MSM acquiring as many as 7 to 10 or more viruses....

[Guest guest]

Thanks, Jules. My approach has been to play safe with other poz guys even though I have had VL measured consistently below detectability for 5 years, One problem is the still uncertain risk associated with multiple HIV infections and the other is all the OTHER stuff out there that is transmitted in the same way as HIV, including hep C for those not yet infected. Syph and gonorrhea con be transmitted both through oral and anal sex. And there are others.

Jerome

In a message dated 5/16/2010 8:43:02 P.M. Eastern Daylight Time, JuLev@... writes:

I did a little investigating with one of thw study authors I know and it appears the answer to your question was he doesnKt know how a person with undectable VL would respond to getting infected with such a virus(s) but he siad it can't be good.

[Guest guest]

Hi Jules

For me there is an important difference between 'can't be good' and 'may be bad'.

One assumes any additional infection, by definition, is not going to do you any benefit and should be actively avoided, but the second doesn't necessarily follow from the first.

Within weeks of infection, we all have multiple viruses, that continue to expand and diversify until treatment gets viral load to <50 copies/mL, when the viral evolution more or less stops. The various recombinant strains of HIV globally, also don't appear to have significant differences in progression rates or responses to treatment. Subtype B, or recombinant B/E or recombinant A/B all pretty much respond the same to treatment. I don't see the potential consequence of infection with other HIV strains as any different to this. I think this research into range of source infection is interesting, but I haven't seen anything that relates this to a poorer clinical outcome. I don;t think this research itself provides any indication of poorer clinical outcomes.

The really important exception where a negative clinical consequence has been proven is with resistance. People who have been reinfected with resistant virus, have been documented to have their treatment combination fail, and future options reduced.

If HIV-positive people want to drop condoms, then the most important information to know is your partners treatment history in terms of resistance, and then I guess their viral load. Other sexual infections are clearly a separate risk.

Simon

On Monday, May 17, 2010, at 03:45AM, <solarjerom@...> wrote:

>

Thanks, Jules. My approach has been to play safe with other poz guys even though I have had VL measured consistently below detectability for 5 years, One problem is the still uncertain risk associated with multiple HIV infections and the other is all the OTHER stuff out there that is transmitted in the same way as HIV, including hep C for those not yet infected. Syph and gonorrhea con be transmitted both through oral and anal sex. And there are others.

Jerome

In a message dated 5/16/2010 8:43:02 P.M. Eastern Daylight Time, JuLev@... writes:

I did a little investigating with one of thw study authors I know and it appears the answer to your question was he doesnKt know how a person with undectable VL would respond to getting infected with such a virus(s) but he siad it can't be good.

[Guest guest]

Certainly what you say about resistance is a likely concern, that one can get infected with a virus that has drug resistance and that would not be good. It does appear that the impact of getting infected with multiple recombinant viruses has not be well characterized and at first blush there does ot appear to be a lot of negatives but I would not be so quick to express this as a firm opinion, I thik we do not understand this very well. It does appear that these multiple viruses might create a more virulent situation for patients. I would reserve judgement a little. The study researcher I asked his opinion said: "...the contribution of this observation may not be very significant in any 1 individual. But I think it is fair to say that being infected with multiple strains of the virus likely will put someone at risk of being infected with a more pathogenic strain, so on balance it is likely something you would not want to happen. As for the implications for a person infected with an undetectable viral load, we know a second infection can occur in this setting and that the second infection can be a more virulent virus....the message to avoid additional viral exposure seems prudent". Until SMART came out a lot of advocates & patients thought interruptions wre not harmful & in fact they were encouraged, but some thought before SMART that interruptions were likely to be harmful.

Jules

Re: NATAP: MSM Get Multiple HIV Viruses

Hi Jules For me there is an important difference between 'can't be good' and 'may be bad'. One assumes any additional infection, by definition, is not going to do you any benefit and should be actively avoided, but the second doesn't necessarily follow from the first. Within weeks of infection, we all have multiple viruses, that continue to expand and diversify until treatment gets viral load to <50 copies/mL, when the viral evolution more or less stops. The various recombinant strains of HIV globally, also don't appear to have significant differences in progression rates or responses to treatment. Subtype B, or recombinant B/E or recombinant A/B all pretty much respond the same to treatment. I don't see the potential consequence of infection with other HIV strains as any different to this. I think this research into range of source infection is interesting, but I haven't seen anything that relates this to a poorer clinical outcome. I don;t think this research itself provides any indication of poorer clinical outcomes. The really important exception where a negative clinical consequence has been proven is with resistance. People who have been reinfected with resistant virus, have been documented to have their treatment combination fail, and future options reduced. If HIV-positive people want to drop condoms, then the most important information to know is your partners treatment history in terms of resistance, and then I guess their viral load. Other sexual infections are clearly a separate risk. Simon On Monday, May 17, 2010, at 03:45AM, <solarjerom@...> wrote: >

Thanks, Jules. My approach has been to play safe with other poz guys even though I have had VL measured consistently below detectability for 5 years, One problem is the still uncertain risk associated with multiple HIV infections and the other is all the OTHER stuff out there that is transmitted in the same way as HIV, including hep C for those not yet infected. Syph and gonorrhea con be transmitted both through oral and anal sex. And there are others.

Jerome

In a message dated 5/16/2010 8:43:02 P.M. Eastern Daylight Time, JuLev@... writes:

I did a little investigating with one of thw study authors I know and it appears the answer to your question was he doesnKt know how a person with undectable VL would respond to getting infected with such a virus(s) but he siad it can't be good.

[Guest guest]

"If HIV-positive people want to drop condoms, then the most important information to know is your partners treatment history in terms of resistance, and then I guess their viral load. Other sexual infections are clearly a separate risk."I believe that there is a real risk of superinfection, and I believe there are doccumented cases where superinfection has lead to accellerated disease progression.On the other hand, if it were that big an issue, everyone in Palm Springs, Fort Lauderdale, San Francisco, etc, would be dead.There is a finite risk. You'll have to make your own choices. Personally, I'm much more afraid of other STDs than I am of another strain of HIV.JB