New York City Public Health Officials Announce Detection of Rare Strain of HIV, Issue Alert
New York City Department of Health and Mental Hygiene officials on Friday at a news conference announced they have detected in a local patient a rare strain of HIV that is highly resistant to most antiretroviral drugs and causes a rapid onset of AIDS, the New York Times reports. The city health department also issued an alert to physicians, hospitals and medical providers asking them to test all HIV-positive patients for evidence of the strain (Santora/Altman, New York Times, 2/12).
City Health Commissioner Thomas Frieden said, "We have not seen a case like this before. It holds the potential for a very serious public health problem" (Goldman, Bloomberg News/Philadelphia Inquirer, 2/12). Although drug-resistant HIV strains are common in patients who have been treated with antiretroviral drugs, multiple-drug-resistant HIV is "extremely rare" in patients who are newly diagnosed and previously untreated, according to a health department release (New York City Department of Health and Mental Hygiene release, 2/11).
In addition, HIV infection usually takes about 10 years to progress to an AIDS diagnosis, but this patient apparently progressed to AIDS in a matter of months. This combination of highly drug resistant HIV and rapid disease progression has not been identified before, Long Island Newsday reports.
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 drug-resistant HIV and the patient's "rapid clinical and immunological deterioration is alarming" (Kerr , Long Island Newsday, 2/12).
"We're talking about a single case," Ronald Valdiserri, deputy director of CDC's National Center for HIV, STD and TB Prevention, noted, but he added that the case is "quite alarming" and should serve "as a wake-up call to remember that HIV is still a formidable adversary" (Edozien, New York Post, 2/12).
The virus was discovered in a New York City man -- whose name has not been released -- in his mid-40s who had frequent, unprotected anal intercourse with other men, often while using crystal methamphetamine, the AP/Yahoo! News reports (Dobnik, AP/Yahoo! News, 2/12). The strain, which is being called 3-DCR HIV, is resistant to three of the four classes of antiretroviral drugs, which means that 19 of the 20 available antiretroviral drugs would be ineffective for a person with this HIV strain (New York Post, 2/12).
The patient was diagnosed as HIV-positive in December 2004 and already showed symptoms of AIDS despite a relatively recent infection. The man had tested HIV-negative as recently as 2003, according to the New York Times (Perez-Pena, New York Times, 2/12). Frieden said that based on early investigations, the patient could have developed AIDS in as little as two months or as much as 10 months after infection (Santora/Altman, New York Times, 2/12). Doctors at the Diamond AIDS Research Center recognized that the virus seemed to be a rare and "more dangerous" strain of HIV, and contacted city officials on Jan. 22, the New York Times reports.
City officials repeatedly analyzed the conclusions before making a public announcement, according to the New York Times. Efforts to locate the man's sexual partners began immediately (Perez-Pena, New York Times, 2/12). The patient has been "extremely cooperative" with officials in tracking down his sexual partners, possibly "hundreds of them," the city health department said on Saturday, according to the New York Post.
Officials said some of the man's partners already have been contacted and tested but locating everyone is an "ongoing effort," according to health department spokesperson Sandra Mullin, who added that no one else had tested positive for the new strain (Montefinise et al., New York Post, 2/13).
Frieden said the case should focus increased attention on the importance of using protection during sexual intercourse, according to the AP/Albany Times Union (Dobnik, AP/Albany Times Union, 2/12).
Men who have sex with men and especially MSM who use crystal methamphetamine should be particularly careful to practice safe sex, he added (Talaga, Toronto Star, 2/12). "It's a new warning ... that safe sex practices remain the most effective way of preventing any HIV infection," Dr. John Greenspan, director of the AIDS Research Institute at the University of California-San Francisco, said (Perlman, San Francisco Chronicle, 2/12).
New York City Mayor Michael Bloomberg (R) said the new strain was "very worrisome," adding, "More than ever ... try not to engage in the drug culture at all, and in terms of unprotected sex, you are putting your life in jeopardy, and if you are infected, you are putting other people's lives in jeopardy" (Burdi, Long Island Newsday, 2/13).
Ana Oliveira, executive director of Gay Men's Health Crisis, said, "We need to practice safer sex," adding, "New Yorkers must be vigilant and know that infection with resistant strains of HIV can be avoided" (Kerr , Long Island Newsday, 2/12).
The "ultimate significance" of the new strain is still "unknown," the Washington Post reports. "Only time will tell whether this was an isolated case or part of an outbreak of similar cases," Frieden said on Saturday, adding, "Only time will tell how widespread it becomes. But it is certainly possible to reduce its spread through prompt action, and that is what we are trying to do."
Terje Anderson, executive director of the National Association of People with AIDS, said he is "uncertain" about the case's importance, according to the Post. "It really isn't clear what one case means," he said, adding, "It is premature to be talking about a 'supervirus' circulating out there in the population."
Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, said the discovery is "not good news no matter how you slice it," but the new case will not necessarily transform the HIV/AIDS epidemic, according to the Post.
The case could "turn out to be a rare event highlighting the need for better AIDS prevention strategies," or "it may mark the emergence of a very dangerous HIV strain whose spread could have global health implications," the Post reports (Brown, Washington Post, 2/13).
NPR's "All Things Considered": The program on Saturday included comments from Frieden about New York City's response plan, including partner notification, strengthening the city's monitoring system and emphasizing drug adherence (Ludden, "All Things Considered," NPR, 2/12). The complete segment is available online in RealPlayer.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.