Dual infection can have a harmful effect on your health. Superinfected individuals may have higher viral loads and lower CD4 counts, which causes more rapid disease progression. And the disease’s progression can accelerate after a second virus appears. Superinfection may also affect treatment of HIV, as it increases the likelihood of drug resistance, and you may not respond as well to available antiretroviral medication due to resistant strains.
What don’t we know?
There is a lot we still do not know about superinfection. First of all, we need to be more sure about whether superinfection actually occurs between HIV-positive persons. A definitive case of superinfection has not been documented, which would require that the timing of the second infection be traced to a relationship with a new sexual partner.
Second, we need to understand how and when superinfection occurs. Among researchers some consensus is developing about the idea that HIV-positive persons in early infection—and particularly the first year of infection—may be at higher risk for superinfection than others. We also should determine whether people with suppressed viral load on treatment are more susceptible to superinfection.
Third, we need to know how to protect against superinfection. If superinfection is rare, or if it only happens in recent infection, it is important to determine what makes an HIV-positive person immune to acquiring a second virus. It would be important to know, for example, if exposure to different viral strains may provide protective immunity against superinfection.
Lastly, we must continue to provide up-to-date scientific data on superinfection, its causes and consequences to HIV-positive people and health care professionals who work with them.
What do you recommend right now?
Counseling about superinfection should be based on understanding an individual’s sexual relationships. Before providing advice about superinfection, a counselor should know whether you are in a continuing relationship with another HIV-positive partner, whether you routinely seek out other HIV-positive partners for unprotected sex, and whether there is disclosure of HIV status with prospective partners. This background should inform the discussion about the risks and benefits of sex among HIV-positive partners. If the counselor does not have time to consider these personal issues, it would probably be best to simply say, “There is not enough information available about superinfection. If superinfection occurs at all, it probably occurs in the first few years after infection. After that, it may be rare.”
Even less is known about superinfection as a result of sharing needles, although it is reasonable to expect the same pattern of initial high risk followed by low risk during chronic infection. However, because intravenous drug users are at high risk of hepatitis C infections from sharing needles, efforts to obtain clean needles through needle exchange should always be emphasized. People with multiple sexual partners, or partners with multiple partners, should be counseled regarding the risks of other sexually transmitted infections. Vaccination for hepatitis B and periodic testing for syphilis is warranted.