On February 11, 2005, the New York City Department of Health and Mental Hygiene (DOHMH) reported a case of HIV infection with a strain that is resistant to many drugs in three classes of HIV medications, and which appears to have progressed to AIDS within 4 to 20 months after infection. We continue to move forward in our investigation to identify the source and potential spread of this strain.
Since the announcement of this case, the DOHMH has been working to identify sexual partners, and urge them to be tested. We have also been working with laboratories performing genotyping and phenotyping tests to identify potential matches between this patient's strain and others and to identify potential links in our investigation.
As we said on the day we made this announcement, we do not yet know whether this patient's combination of drug resistance and rapid progression of HIV to AIDS is an isolated event or is more widespread. As we also said on that day, we do not know what the clinical course will be for the affected patient.
Several things are known:
- Drug-resistant HIV is increasingly occurring among HIV-infected individuals, including those with no prior treatment. The case in question reflects a trend of increasing drug resistance; this is a trend that greatly complicates the care of persons living with HIV/AIDS. We are encouraging drug resistance testing for all persons newly infected with HIV. As we indicated in our Alert to physicians on February 11, to reduce the development of drug resistance, physicians should support patient adherence through simplification of drug regimens and provision for housing, mental health, and drug abuse treatment support.
- Unsafe sexual practices among men who have sex with men are leading to preventable HIV infections as well as to an increase in syphilis and a rare sexually transmitted disease -- lymphogranuloma venereum. Safer sex practices are critical and condoms need to be much more widely available and more reliably used.
- Because so many HIV-infected people don't know their status, we need to increase HIV testing, particularly through wider use of rapid testing provided in a voluntary and confidential manner.
- The rapidly growing use of crystal methamphetamine in New York City continues to play a significant role in facilitating the transmission of HIV.
- Tracking systems must be improved to monitor HIV drug resistance patterns in people infected with HIV.