HIV super strain revisited.(IN THE NEWS)

In the April 2005 edition of The Center for AIDS Information & Advocacy HIV Treatment ALERTS! we reported the strange case of a 40-something year old, gay man in New York City (referred to as NYC) who appeared to be newly infected with a form or "strain" of HIV that was resistant to the 3 main classes of HIV drugs. To complicate matters, his disease was quickly progressing to the clinical definition of AIDS (very low T-cell count). At the time, the scientific community was very concerned because this case highlighted the possibility that there was a new strain of HIV that could not be treated with available HIV meds and that was being spread through unprotected sex. After testing positive for HIV in December 2004, NYC quickly progressed to having AIDS in a matter of months. In spite of this diagnosis, the man reportedly continued to have unprotected anal sex with multiple partners, often taking methamphetamine ("meth") too.

Although such cases had been extremely rare until this point, the media was quick to grab hold of the story, warning of "a new, impossible-to-treat strain of HIV." Public Health departments used the case as "a wake-up call to men who have sex with men," urging them to take action and prevent the "devastation" that the spread of this drug-resistant strain of HIV could cause. Some of the media sources seemed to be reviving the public outrage of the early days of the AIDS epidemic. By giving the new strain a name, "3DCR-HIV" (short for "3-drug-class-resistant HIV"), the New York City Health Department drew parallels to an unnamed new virus that was called "GRID," or gay-related infectious disease. The case also renewed the debate here in the US about the best way to teach sex education and HIV prevention--comprehensive versus abstinence-only programs. Even at that time, many in the medical community warned against spreading panic unnecessarily. The specific details of the NYC case had not been reported in a scientific journal, only in the mainstream press, an information source not known for its objective news coverage. The ALERTS/cautioned our readers not to overreact before more details were known.

Finally, 2 years later, the first comprehensive report on the case has been published in the May 1st Journal of Infectious Diseases. Not surprisingly, most of the assumptions about the case turned out to be wrong. Ongoing studies of the NYC patient now suggest that he may have been infected with a very resistant strain of HIV rather than having developed it himself. The rapid drop in his T cells was probably caused by primary infection rather than the extremely rapid course of infection that was first reported. The person who infected NYC (let's call him John) was finally identified; it was discovered that the virus John was infected with was very drug-resistant and that his regular sexual partner (let's call him Bob) was also infected with a very drug-resistant virus.

NYC's initial AIDS diagnosis and status as a "rapid progressor" were based mostly on his very low T-cell count of 80. He showed no signs of serious disease progression other than fever, sore throat, weakness, fatigue, and weight loss, all of which are common symptoms of primary infection. ...