Posted on 02/06/2006 5:33:23 PM PST by rapture76
RIO de JANEIRO, Brazil, July 25-A Connecticut doctor said today that his patient is the source of the highly publicized, rapidly-progressing, multi-drug-resistant HIV strain that aroused considerable concern when a New York man was infected earlier this year.
"However," said Gary Blick, M.D., a private practice physician in Norwalk, Conn., "we want to emphasize that our patient is not rapidly progressing. Nor is that patient's life partner, who is also infected with a similarly highly resistant strain, rapidly progressing."
The reason the infected New York City man's immune system suddenly deteriorated in a three-month period might have had more to do with that patient's sex and drug habits than the HIV strain, he reported at the Third International AIDS Society Conference on HIV Pathogenesis and Treatment.
Despite comments from New York City officials that the source of the strain could not be found, Dr. Blick said that he was informed early in the investigation that his patients had strains of HIV that were 99.5% and 98.5% identical to the New York man's HIV.
"When the HIV strain is only about 1% different than another, they are usually almost identical," he said. HIV mutates so rapidly that 100% identical strains are uncommon if the patients are tested at different times.
In interviews with his patients and information he gathered from New York sources, Dr. Blick was able to determine how the New York man was infected with his "Patient Zero" that he identified as patient CT01.
He said CT01 is a 52-year-old man with a long history of HIV infection. Over the course of his disease, CT01 became experienced with 14 different antiretroviral drugs but is able to keep his viral load undetectable on a combination of Sustiva (efavirenz), a non-nucleoside reverse transcriptase inhibitor, and Fuzeon (enfuvirtide), an injected drug known as an entry inhibitor.
"Interestingly," Dr. Blick said, "those are the only drugs that appear effective in the New York City case."
On Oct. 20, 2004, Dr. Blick collected a virus sample from CTO1. At that time the man had missed several doses of Fuzeon and his viral load was in the detectable range. He and his life partner -- CT02 -- then traveled to New York City and engaged in unprotected sex with the New York City case at a sex club where individuals engaged in unprotected anal intercourse with the New York City man.
Dr. Blick said his patients were devastated to find out they had transmitted the disease because they believed that all the people at the club were HIV-positive.
Marc Wainberg, Ph.D., professor of medicine at McGill University in Montreal, said at the IAS meeting that he thinks Dr. Blick is correct in identifying his patients as the source of the highly publicized New York case.
"The pylogenic evidence is very convincing that he has identified the two patients that are the source of this strain of disease," Dr. Wainberg said. He said that the reason the New York City man has rapidly progressing disease was more likely due to that patient's frequent use of crystal methamphetamine and frequent sexual partners.
According to published reports the New York City man had sex with at least 10 other partners before he discovered he was infected.
Dr. Blick said it is possible other infections with that strain may show up later when those men are tested, if they in fact were infected.
He also said that the investigation of the case established that CT02 has contracted a superinfection of HIV. The 41-year-old man (CT02) had been infected with a completely different strain when he began his relationship with CT01 12 years ago. Recent tests, however, found that he was infected with both the original strain and his partner's strain.
The superinfection -- meaning a secondary infection -- occurred sometime after August 2001, according to the analyses performed by various laboratories, Dr. Blick said.
He said that the superinfection between two partners might reinforce recommendations that even when individuals who are both infected by HIV have sex that safe sex activities are warranted.
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