Question:

My boyfriend is taking Combivir and Sustiva tablets. We have been dating since October of last year and I just would like to get more information about the risk of partners barebacking if one is HIV positive and the other that is doing the barebacking is not [HIV positive]. I have done some reading on my own but have not found the answers I am seeking. Any information that you can give me would be great. I get an HIV test every six months, or at least once a year. I don 't fear HIV and AIDS because I know it is out there and if I am going to be with someone that is HIV+ then I think it is only fitting to gather as much, if not more, information then I already have and know.

I thank you for your time and help.

Answer provided by:

Marty Markowitz, M. D.
Clinical Director
Staff Investigator, Aaron Diamond AIDS Research Center
Associate Professor, Rockefeller University

This is a most challenging, but common question.

1. Transmission during unprotected anal intercourse be it insertive or receptive is well documented. If the active partner is uncircumcised, the risk is higher than if circumcised.

2. Transmission from treated patients to uninfected patients is documented.

3. However, there is no report of transmission from a patient with a persistent VL below detection while on therapy. Therefore the risk is likely to be quite low.

4. In studies of serodiscordant heterosexual couples in Africa- plasma viral load correlated with risk of transmission...no transmissions occurred at levels less than around 1000 copies. However, this is NOT a treated cohort...it is a natural history cohort.

5. MOST IMPORTANT- sex practices are somewhat habitual...meaning..if you do not practice safe sex routinely...you are less likely to do so if you have sex outside your relationship or enter into a new relationship.

These are the facts and opinions...the rest is up to you.

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