Drug-Resistant HIV Strain in NYC Patient Similar to Treatable Canadian Cases; Debate Over Announcement Continues

The rare, drug-resistant HIV strain recently detected in a New York City man appears to be "similar in some ways" to two HIV cases in Canada that first appeared in 2001 and did not lead to the spread of a "supervirus," the Washington Post reports. Both cases -- despite "worrisome features" -- were treatable with three- or four-drug combinations, including antiretroviral medications in the same classes of drugs that the virus was resistant to in lab tests, according to the Post. The cases also involved a drug-resistant strain and rapidly evolving virus, although neither case was "as extreme" as the strain found in New York City, according to the Post (Brown, Washington Post, 2/19). Officials from the New York City Department of Health and Mental Hygiene on Feb. 11 announced they had detected in a local man a rare strain of HIV that is resistant to most antiretroviral drugs and possibly causes a rapid onset of AIDS. The city health department issued an alert to physicians, hospitals and medical providers asking them to test all HIV-positive patients for evidence of the strain. Dr. David Ho, director of the Aaron Diamond AIDS Research Center -- where the patient was diagnosed as HIV-positive in December 2004 -- said the combination of highly drug-resistant HIV and rapid progression to AIDS had not been identified before (Kaiser Daily HIV/AIDS Report, 2/18). Drug-resistant HIV can be treated using specific drug combinations or higher doses of medications, according to the Post. The New York patient's rapid progression to AIDS could indicate an "especially virulent" HIV strain or mean the man had a "pre-existing weakness" in his immune system, according to the Post. The two Canadian men in the previously detected cases currently are in good health, according to Julio Montaner, chair of AIDS research at the University of British Columbia and the physician who treated the men. However, he said that the New York case is "more florid, with more resistance" than the Canadian cases and that the New York man is sicker than the Canadian patients (Washington Post, 2/19).

Debate Over Announcement
Debate over the New York City public health department's announcement of the rare strain has not "abated," as experts and advocates continue to discuss whether such an alert was needed, the New York Times reports. Some scientists immediately "dismiss[ed]" the news as an "isolated" case that was "unworthy of alarm," and other researchers said there is not yet adequate research to necessitate a public health alert and accused New York City Health Commissioner Thomas Frieden, who made the announcement, of "excessive haste," according to the Times. The findings demonstrate the "intense competition" among scientists to "communicate new findings and get credit" in order to obtain funding for expanded research, according to the Times. Frieden defended his decision to go public, saying that although the announcement "clearly contained cautions and unknowns," it was necessary because of the potential public health effects, according to the Times. "We had enough clinical and scientific information to warrant making the announcement because of the immediate implications for the community and for doctors practicing in New York City," he said. Gay advocates said they are concerned that the announcement would "set up gay men as culprits" and that the alert was used as a "scare tactic" designed to prompt men who have sex with men to practice safer sex, an accusation that Frieden denied, the Times reports. "Rather than increasing awareness of the risks of unsafe sex and crystal [methamphetamine] use, the health department risks stigmatizing gay men as crazed drug addicts carelessly or wantonly spreading a killer bug," the Community HIV/AIDS Mobilization Project said in a statement (Santora et al., New York Times, 2/21).

San Diego Case
The announcement last week that a San Diego resident had a drug-resistant HIV strain similar to the New York case was inaccurate, San Diego County Public Health Officer Nancy Bowen announced on Friday, the AP/San Jose Mercury News reports. A search of laboratory records showed that an allegedly similar HIV strain was detected last fall in an unidentified San Diego patient, which prompted health officials to search for the person, according to the AP/Mercury News. However, the patient does not live in the San Diego area, and for privacy reasons, the lab did not tell county officials where the test was from, San Diego County Health and Human Services spokesperson Leslie Ridgeway said (AP/San Jose Mercury News, 2/18).

Methamphetamine, HIV Link
The New York Times on Tuesday examined a possible "biological relationship" between HIV and methamphetamine. The drug, which often is called crystal meth or speed, is "most troubling to health officials because of its role in blotting out inhibitions and fueling high-risk sexual behavior," according to the Times. Experts say they are "grappling" with additional evidence that the drug might increase a person's susceptibility to HIV infection by harming the immune system and aiding in disease transmission (O'Connor, New York Times, 2/22). Toronto's Globe and Mail on Saturday examined meth's association with HIV transmission, a concern that has prompted the AIDS Committee of Toronto to apply to Health Canada for support in creating a crystal meth awareness campaign and a new study that would interview crystal meth users (Proulx, Globe and Mail, 2/19).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, or sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv. The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of the Kaiser Family Foundation, by The Advisory Board Company. © 2004 by The Advisory Board Company and Kaiser Family Foundation. All rights reserved.