Super-infections

Discussion in 'Sex With a Large Penis' started by Imported, Mar 25, 2003.

  1. Imported

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    AnonyMs: Got this in the corporate email today and wanted to share it with you all.

    Superinfection Can Occur!
    Corklin R. Steinhart, MD, PhD

    · "Superinfection," i.e. infection with a second strain of HIV during the course of an established HIV infection, thought to be a rare event
    · Case report (Jost et al. N Engl J Med. September 5, 2002; 347 (10): 731-36) of a 38 y/o European male who was infected with a different strain (clade) of HIV ~3 years after initial infection
    o Infected 11/98 with HIV-1 subtype AE and HBV
    o Treated with both HAART and an HIV vaccine with excellent immunologic and virologic responses
    o 4/2001 developed mild flu-like illness
    § Had traveled to Brazil and had several unprotected sexual encounters
    § Was off HAART for several months
    § Also determined to have acquired HCV infection as well!
    o Had very high viral load for subsequent 3-4 months with profound decrease in CD4 count
    o Thorough analysis revealed that he had definitely been infected with a different subtype (B) that lead to rapid progression of disease
    o Conclusions
    § Case clearly demonstrates that superinfection can occur
    § Previous HIV infection does not lead to prevention of infection with a different sub-type
    § Supports the use of save sex practices in HIV-infected persons

    · Commentary (Goulder and Walker. N ENGL J Med. September 5, 2002; 347 (10): 756-58)
    o Previous observations have demonstrated that effective immune responses are generated following acute HIV infection but they are sub-optimal
    o The case describe above challenges conventional wisdom that established HIV infection does protect against infection with a second HIV-1 sub-type and, therefore, that a broadly based HIV vaccine could be developed
    o However, the frequency of superinfection generally occurring remains unknown
    o Does not answer the question of superinfection with the same HIV-1 subtype
    o Implications for public health are clear!
    § Infection with one sub-type does not protect against subsequent infection with another sub-type!
    § Superinfection may lead to a more progressive disease course
    § The increased unprotected sexual activity that is presently occurring between HIV-infected persons clearly implies that "vigilance to prevent HIV-1 exposure" is needed in both non-HIV-1 infected and HIV-1 infected persons

    o Many questions, however, remain unanswered
     
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