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2005-03-17-New Yorker's Rapid HIV Seen as Danger Sign
Fast-Moving, Drug-Resistant AIDS Virus Points to Prevention Failure
The drug-resistant AIDS virus that emerged in New York is a warning that HIV prevention efforts are failing, public health experts warn.
Last month, the New York City health department announced alarming news. A man developed AIDS only months after getting infected with an HIV strain resistant to most anti-HIV drugs. Usually the virus takes many years to cause disease.
The announcement led to speculation that a "supervirus" may have evolved. But it's not the first time a highly resistant AIDS virus has been linked to rapidly worsening HIV disease. And it's not yet clear whether the New Yorker's extremely fast progression from infection to AIDS is due to the virus, to the man's genetic makeup and underlying health, or to both.
Public health experts are tracing the man's many sex partners. So far, there's been no report that anyone else is infected with the same drug-resistant HIV. But the case still is a concern, says infectious disease expert Carlos del Rio, MD, chief of medicine at Atlanta's Grady Memorial Hospital and former executive director of Mexico's national AIDS agency.
"Are there more cases like this out there? Probably," del Rio tells WebMD. "But if there were a cluster of cases -- five or six people linked by sex who all progressed rapidly to AIDS -- I would be more concerned."
That hasn't happened yet. But in their official report on the patient - in the March 19 issue of The Lancet - Martin Markowitz, MD, and colleagues at New York's Aaron Diamond AIDS Research Center say "the public health ramifications of such a case are great." They also suggest that the findings "raise the specter that this strain of HIV-1 might be especially aggressive," although "the cause of the observed clinical course in this man remains unclear."
But the still-incomplete evidence suggests that the man was especially unlucky, says Eric Daar, MD, chief of HIV medicine at Harbor-UCLA Medical Center in Los Angeles. He was infected with a more-virulent X4 form of HIV that usually arises only after years infection, when AIDS symptoms finally appear.
"This person is one of the unfortunate few who did acquire this type of virus," Daar tells WebMD. "For reasons not well understood, infection by these X4 viruses doesn't seem to occur efficiently. In all likelihood, that will be the case here as well. So this case is alarming but not novel. The history is reassuring that we are not going to see an epidemic of this so-called superbug."
Del Rio says there is one thing about the case that is absolutely clear.
"This is telling us that AIDS prevention programs have been a failure," del Rio says. "U.S. AIDS prevention is nowhere near where it needs to be. In this country we have an unacceptably high number of people who get HIV every day. We have grown accustomed to this. But it is something we need to be much more aware of. This case should tell us something."
Del Rio notes that the New York patient, a gay man, frequently used methamphetamine, a drug known to lower sexual inhibitions and increase the likelihood a person will have sex without a condom.
"The intersection of the methamphetamine epidemic and the HIV epidemic is deadly," he says. "We need to not forget that. This is something being fueled by methamphetamine abuse."
Daar says it's not just a New York phenomenon. Methamphetamine abuse -- "crystal meth" in drug parlance -- is a coast-to-coast problem.
"Ninety percent of our newly infected people report crystal meth use," he says. "There is a huge epidemic of crystal meth use. And probably more so in the gay white male community than others. It is highly addictive and prevents people from using good judgment. It is a major driving force behind the epidemic. Unfortunately, we [in AIDS prevention] are not very good at dealing with substance abuse in the communities we serve."
A coalition of 41 AIDS organizations -- including the National Association of People with AIDS, Gay Men's Health Crisis, and the Treatment Action Group -- warns against stigmatizing gay men as "crazed drug addicts carelessly or wantonly spreading a killer bug."
The groups' joint statement points to several troubling trends:
Cuts in federal funding for AIDS prevention programs
Restrictions on the content of information distributed by federally funded prevention programs which "make honest discussions of sex and drugs increasingly difficult."
Political attacks on "harm reduction" programs that try to reduce the dangers of drug use.
Punitive audits of federally funded programs specifically focused on gay, lesbian, and transgendered people and on women's reproductive health.
"Counseling to reduce risk of infection or address issues of drug use must be made in the context of confronting the underlying issues that fueled HIV transmission," the statement says.
SOURCES: Markowitz, M. The Lancet, March 19, 2005; vol 365: pp 1031-1038 and 1003-1009. Treatment Action Group. Carlos del Rio, MD, chief of medicine, Grady Memorial Hospital; director, Emory University AIDS International Training and Research Program, Atlanta. Eric Daar, MD, chief of HIV medicine, Harbor-UCLA Medical Center, Los Angeles; professor of medicine, David Geffen School of Medicine, UCLA.