2.12.2005

It Hasn't Just Gone Away . . .

Resistant HIV alarms New York
By Marc Santora, Lawrence Altman New York February 13, 2005

A rare strain of HIV that is highly resistant to virtually all anti-retroviral drugs and appears to lead to the rapid onset of AIDS was detected in a New York man last week, city health officials have announced.
It was the first time a strain of HIV had been found that showed resistance to multiple drugs as well as leading to AIDS so quickly, the officials said. While the extent of the spread of the disease is unknown, officials called a news conference on Friday to say the situation was alarming.
"We consider this a major potential problem," the commissioner of New York's health and mental hygiene department, Dr Thomas Frieden, said.
The department alerted all hospitals and doctors in the city to test all newly detected HIV cases for evidence of the rare strain.
The virus was found in a man in his mid-40s who engaged in unprotected sex with other men on multiple occasions while using crystal methamphetamine. The drug's erasure of inhibitions and stimulating effect have long been blamed by health officials for sex marathons that have increased the spread of HIV.
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The man, who was not named, is believed to have had unprotected sex with hundreds of partners, according to one person familiar with the case.
Some AIDS specialists around the country were sceptical of the alarm, believing that it might be an isolated case related to the patient's immune system. But Dr Frieden said the case increased the importance for gay men of practising safe sex.
"This case is a wake-up call," he said. "First, it's a wake-up call to men who have sex with men, particularly those who may use crystal methamphetamine. Not only are we seeing syphilis and a rare sexually transmitted disease - lymphogranuloma venereum - among these men, now we've identified this strain of HIV that is difficult or impossible to treat and which appears to progress rapidly to AIDS."
While HIV strains that are resistant to some anti-retroviral drugs have been on the rise in recent years, both in New York and nationally, city and federal officials said the new case was worrying for several reasons.
The viral strain was resistant to three of the four classes of drugs used to treat HIV from the moment the patient was infected. Typically, drug resistance comes after a patient is treated with retroviral drugs, often because they veer from the prescribed course. And, more often than not, a person is resistant only to one or two classes of drugs.
But in this case, the drug resistance came in combination with a rapid transformation into AIDS. Both of those things have been seen before, but not together.
"What's unique about this is the combination of multiple drug resistance and a rapid course," the director of HIV/AIDS prevention at the Centres for Disease Control in Atlanta, Dr Ronald Valdiserri, said. "To folks in the public health community, that is a particularly dangerous combination."
He said that while it was an isolated case at this time, the centres had informed health departments around the country out of concern.
Dr David Ho, director of the Aaron Diamond AIDS Research Centre in New York, which did the testing that identified the rare strain, described the convergence of the two problems as "a scary phenomenon".
But not everyone agreed.
Dr Robert Gallo, co-discoverer of the AIDS virus and director of the Institute of Human Virology at the University of Maryland, was sceptical of Friday's announcement. "My guess is that this is much ado about nothing," he said. "Though it's prudent to follow it, I don't think it's necessary to issue a warning or alert the press."
Dr Gallo said it was well known that some patients progress from initial infection to full-blown AIDS very rapidly, but this was usually because the patient was highly susceptible, not because the virus was virulent. He said this case, where the virus was both drug-resistant and the progression rapid, was rare but not necessarily alarming.
Dr Frieden said the limited epidemiological investigation in this case showed that the patient could have developed AIDS in as little as two months, but that it might have taken as long as 10 months.
On average, it takes 10 years from the time a person is first infected with HIV to the development of AIDS.
At the news conference, held in New York, Dr Frieden was joined by nearly a dozen community leaders and medical experts in AIDS.
Several participants said they were experiencing the same worried feeling they had more than two decades ago, when AIDS first appeared and there was still no treatment.
- New York Times

When Miss Hag. was a wee one, AIDS became a frightening phenomenon, but she was far removed from its direct effects in her wee little hometown. Since moving to New York and falling madly in love with a community of middle aged gay men, that is not so. I witnessed a frightnening conversation this morning. Several of my closest gay male friends were more than a little upset by the bold scary headlines on the Daily New and the Horrible Post. A new form of AIDS. Deadlier. Faster. Resistant to drugs.

Things were said like, "We knew this was coming . . ." Murmuring discussions of watching so many friends pass away so quickly. Miss Hag. got scared. My life is vastly intertwined with the gay community. I have been cared for, raised by, befriended by and deeply loved so very many of the New York city gay community. Pop culture is re-embracing the 1980's. Let's hope the part of it is left in the past.
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