Rare and Aggressive H.I.V. Reported in New York

A rare strain of H.I.V. 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 City man last week, city health officials announced on Friday.

It was the first time a strain of H.I.V. had been found that both showed resistance to multiple drugs and led to AIDS so quickly, the officials said. While the extent of the disease's spread is unknown, officials called a news conference to say that the situation is alarming.

"We consider this a major potential problem," said Dr. Thomas R. Frieden, the commissioner of the New York City Department of Health and Mental Hygiene. The department issued an alert to all hospitals and doctors in the city to test all newly detected H.I.V. cases for evidence of the rare strain.

The virus was found in a New York City man in his mid-40's who engaged in unprotected anal sex with other men on multiple occasions while he was using crystal methamphetamine. Health officials have long said that the drug's stimulating effect and erasure of inhibitions contributes to sex marathons that have increased the spread of H.I.V.

The man, whose name was not released to protect his privacy, is believed to have had unprotected sex with hundreds of partners, according to one person briefed on the case who insisted on anonymity because the investigation is continuing.

Some AIDS specialists outside New York City expressed skepticism about the alarm, believing that it might be an isolated case related to the patient's immune system. But Dr. Frieden said the case heightened the importance of using condoms.

"This case is a wake-up call," Dr. Frieden 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 H.I.V. that is difficult or impossible to treat and which appears to progress rapidly to AIDS."

While H.I.V. strains that are resistant to some anti-retroviral drugs have been on the rise in recent years, both in New York City and nationally, city and federal officials said that the new case was worrisome for several reasons.

The viral strain in the unnamed patient was resistant to three of the four classes of drugs used to treat H.I.V. from the start of treatment. Typically, drug resistance occurs after a patient is treated with retroviral drugs, often because the patient veers from the prescribed course. And more often than not, a person is resistant to only one or two classes of drugs.

But in this case, the drug resistance is combined with a rapid transformation into AIDS. Both of those phenomena have been seen before, but are not believed to have occurred together.

"What's unique about this is the combination of multiple drug resistance and a rapid course," said Dr. Ronald O. Valdiserri, the director of H.I.V./AIDS prevention at the Centers for Disease Control. "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 C.D.C. had informed other health departments around the country out of concern.

Dr. David Ho, the director of the Aaron Diamond AIDS Research Center, 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 C. Gallo, a co-discoverer of the AIDS virus and director of the Institute of Human Virology at the University of Maryland, was very skeptical of yesterday'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 that it was well known that some patients progressed from initial infection to AIDS very rapidly, but that it was usually because they were highly susceptible, not because the virus was virulent. He said that this case, in which the virus is drug-resistant and the progression rapid, was rare but not necessarily alarming.

Dr. John P. Moore, an AIDS researcher at Cornell University's Medical School, agreed.

"If there was a cluster of these, that would be different," he said. "But I wouldn't get bent out of shape about what is literally an anecdotal case right now."

The limited epidemiological investigation in this case shows that the patient could have developed AIDS in as little as 2 months, but that it might have taken as long as 10, Dr. Frieden said. On average, it takes 10 years from the time a person is first infected with H.I.V. for AIDS to develop. But it can take only months for some people, and 20 years for others.

At the news conference in Lower Manhattan, Dr. Frieden was joined by nearly a dozen AIDS experts and community leaders. Several participants said they were experiencing the same worried feeling they had more than two decades ago, when AIDS first appeared and there was no treatment.

Health officials cautioned that the emergence of the rare strain did not mean that people who are currently responding well to H.I.V./AIDS treatment needed further testing, unless ordered by a physician. They did warn, however, that people with H.I.V./AIDS could be re-infected with a different and more dangerous strain if they practiced unprotected sex.

More tests need to be completed before it is clear if any combination of drugs can effectively treat this strain of the virus, but Dr. Frieden said that therapy now appeared to be extremely difficult.

The man is currently receiving a cocktail of drugs, including one, Enfuvirtide, that is believed to be effective. Doctors cautioned, however, that single-drug therapy was rarely effective against AIDS in the long term.

From the moment the Health Department learned about this case on Jan. 22, its scientists have been studying complex laboratory tests to decipher the patterns of resistance, and epidemiologists have tried to trace the man's sexual partners and notify them of the potential risk.

In May 2003, the man tested negative for H.I.V., health officials said. Investigators believe he contracted H.I.V. in October 2004, when he engaged in unprotected anal sex with multiple partners while using crystal methamphetamine. The man found some of his partners on an Internet Web site, officials said, though they would not identify the site. Health officials said they were working with those who used the Web site to reach as many people as possible who might have been infected or are worried that they could have been.

Dr. Frieden said in an interview that it was probable that the man had sex with someone who had a strain of H.I.V. that was resistant to multiple drugs.

"Whoever gave it to him most likely did not have sex only with him," Dr. Frieden said.

Health officials became aware of the situation after the man began to feel sick in late November and the next month went to see his doctor, who had him get an H.I.V. test. The test came back positive in December. By January, the H.I.V. had progressed to AIDS.

The man's doctor referred him to the Aaron Diamond AIDS Research Center in Manhattan, where for many years Dr. Martin Markowitz has been conducting a study of patients in the earliest stages of H.I.V.

The Health Department asked doctors to be alert for patients experiencing flulike symptoms who had engaged in high-risk sexual activity. Such symptoms might indicate acute retroviral syndrome, indicating a need for H.I.V. testing

In fact, Dr. Frieden said, all people with newly diagnosed H.I.V. should be tested to see if the strain is drug resistant. But the tests are complex and expensive. Dr. Frieden asked physicians to report any case in which a strain is resistant to three classes of drugs.

Dr. James Braun, the president of the Physicians Research Network, a nonprofit organization formed in 1990 to serve clinicians who treat tens of thousands of AIDS patients, said doctors have been worried for some time about something like this.

"We believe that the transmission of treatment-resistant H.I.V. was a disaster waiting to happen, particularly in communities where safer sex is not practiced regularly and in light of people using drugs like crystal meth," Dr. Braun said. "All primary care providers in acute care settings need to know how to diagnose H.I.V. in its earliest stages and where to refer people so that new infections are properly worked up and treated."

Health officials have been worried for some time that city residents, particularly gay men, are growing lax in their attitudes about sex practices, lulled into complacency by the success of antiviral drugs. In the past four years, the number of new syphilis cases in the city has slowly increased, with gay men accounting for most of them. Only 45 percent of gay men surveyed by the Health Department in 2003 said they used a condom during sex.

An estimated 88,000 New Yorkers have H.I.V./AIDS, and health officials estimate that another 20,000 people are infected but do not know their status. The officials urged all New Yorkers who are sexually active to check on their H.I.V. status.

"Risky behavior may be even more dangerous now, since there is a chance of infection with a virus we may not be able to treat," said Dr. Jay Dobkin, director of the AIDS Program at Columbia University Medical Center.

Is that God handing out a clue? Or evolution in action?

My post is a reference to the name attributed to a disease epidemic among gays. The connection between gays and the disease led scientists to give the disease a very politically incorrect but accurate name. It was only after gays protested that the name was changed. Subsequently, blood donated by gays corrupted the nations blood supply. It was this tainted blood (clotting factor) that ultimately killed the young boy, Ryan White. Ryan White, a hemopheliac, was used as a posterboy by the gay community to brainwash Americans into believing that all Americans, not just gays were susceptible to the gay disease. It is unclear what the connection is between the gay lifestyle/AIDS and the monkey virus, except that gays will undoubtedly try to use it to blame others for the disease.

Not important in the difference at all. That's just how I remember hearing it first referenced.

Although I must admit that I really don't mind the name change as it better reflects the disease thoughout the world, however we should not forget how it spread to other countries (including ours).

Speaking epidemialogically, a quicker killing form of AIDS is really less dangerous to society. By killing its host quicker there is less chance of the infection spreading. Not a pleasant thought, but a scientifically accurate one.

there is a cure for AIDS, the virus dies if people stop behaving in a way that spreads it, oh sorry, like that's going to happen, there is no cure for AIDS

now a famous sex expert, Dr. Sue, one of my favourite sex experts, she looks like anyone's Grandmother but not annoying like Dr. Ruth said that anyone engaging in anal sex should double bag it, as in wear two condoms at once to ensure safer sex, whether hetero or homo, because of that delicate rectal tissue is very prone to tearing and thus tranmission, so if you double bag it, if one condom breaks hopefully the second condom works, personally a friend and mine laughingly suggest whole body condoms or maybe virtual sex is looking better and better or celibacy - this new chladmydia looks nasty too, time to buy stock in vibrator manufacturers, LOL

but you are always going to have assholes who are so stoned or drunk or on the death spiral that they don't care who they infect and some are angry so they want to take as many with them, happened to some creep in Canada who purposely infected women, in fact, this is a good reason for not having casual sex with anyone, this guy infected this one woman, she insisted he wear a condom, so he puts it on but whipped it off at the last moment and gave her AIDS, and this was after this guy was under an order to refrain from having unprotected sex - hmmmmm

I was shocked to learn just a few years ago that most cervical cancers are caused by a sexually transmitted disease, HPV, and you don't even hear about that much

yeah but Mother Nature also takes out innocent victims on this one, like the spouses who don't realize their husbands or wives are fucking around on them with infected people, nor it is fair to children born of AIDS infected mothers, often again infected by their sleazy husbands, look at Africa, in cultures where women cannot refuse their husband sex or they get beaten up, let alone insisting he wears a condom or where women are routinely raped...

I don't know that you can say AIDS is just a gay disease

it seems that AIDS's genesis was in Africa and you have two strains, one in West Africa which was always a milder strain, and almost exclusively a heterosexual virus, and one in East Africa which is the strain that has made its way around the world because of a highly mobile gay community

my understanding is that anal sex is the common denominator and anal sex is more prevalent in African sexual behaviour, heterosexual and homosexual and of course using condoms is still practically non existent,

but I could be admittedly way off base

"Actually, it goes farther back than that. I saw a documentary recently which presented a pretty compelling case that the HIV virus jumped species from chimpanzees through a particular oral polio imunization effort in Africa in the 1950's."

Interesting. See if you can find the link for this one.

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