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Case of Fast Progressing Resistant HIV in NYC: more responses
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Below are three articles following up on the news Friday that a rare case of HIV was discovered in a person in NYC. The person's HIV is fast progressing and is multi-drug resistant to 3 of the 4 classes of HIV drugs available for treatment. There is quite a bit of controversy regarding the presentation of this finding ranging from at one end some advocates saying the news was too sensationalized to folks saying the news worries and concerns them. The news has provoked discussions about the risks of drug use & meth use and 'unsafe' sex. The news appears to have heightened awareness and provoked discussion regarding risky behavior that exposes people to contracting HIV.
Jules Levin
Statement from AIDS Action Committee of Massachusetts, Inc. Rebecca Haag, Executive Director- Response to NYC Case Fast Progressing Resistant HIV
BOSTON, Feb. 12 /PRNewswire/ -- New York, Boston and Providence are so geographically close and people travel among them so frequently, that news from New York is news for Boston and Providence.
Although this is the first reported case, and even if this case is isolated, it is prudent to track this and recognize it as a reminder to focus on the importance of gay men or other men who have sex with men to:
* Practice safer sex,
* Know their HIV status,
* Get help if they are using crystal meth, whether for themselves, friends or family members and
* Reach out to known resources, such as the state's HIV Hotline at AIDS Action, 1-800-235-2331, which is open Monday - Friday, 9 a.m. - 9 p.m. In the Northeast, evidence in the past year shows a clear connection and serious concern between: * high risk behavior,
* crystal meth use and
* infection rates for syphilis and HIV. HIV normally takes time to damage the immune system to the point of acquiring Opportunistic Infections or AIDS. This case, from what has been reported, seems to be progressing quickly, and that is dramatic. While there is variance in the norm, this appears to be FAR outside of the norm.
While this is only one case, the apparent path of this infection has been drug-resistant, and it has a short progression duration.
While we at AIDS Action believe that HIV care needs should be integrated in everyone's primary care, we need to recognize that HIV bears a unique burden of stigma.
We're available. We want for people to reach out for help. We urge people to call the HIV Hotline and talk to supportive people in their network if they need help. We'll continue to monitor this development.
We urge people to:
* Get help with crystal meth
* Be safe during sex
* Reach out to resources, including the statewide HIV Hotline.
Report on a New Form of H.I.V. Brings Alarm, Not Surprise
NY Times
Feb 13 2005
By RICHARD PÉREZ-PEÑA
and MARC SANTORA
As word spread of a rare and potentially more aggressive form of H.I.V., first reported publicly in New York on Friday, communities already hit hard by the disease, professionals who combat it, and people who are infected reacted yesterday with fear and skepticism. But few were surprised, given that the sense of urgency about the disease has waned.
Michael Justiniano, 37, who lives in Park Slope, Brooklyn, said he watched his father die of AIDS in 1993. "I have spoken to young kids, sometimes here, who say, 'If I get it, it's no big deal. I can just take a pill,' " he said. "I'm like, 'Are you stupid?' It is so disgusting. I find it really disturbing."
City health officials announced on Friday that they had detected the rare strain of H.I.V. in one man whose case they described as particularly worrisome because it merged two unusual features: resistance to nearly all anti-retroviral drugs used to treat the infection, and stunningly swift progression from infection to full-fledged AIDS. Scientists say that only with more testing will they hope to determine how virulent the strain is and how specific to this one man its effects are.
That combination drug resistance and rapid AIDS onset, the officials said, could signal a new, more menacing kind of infection, and its discovery set in motion an anxious search by city workers to find the man's sexual partners and have them tested.
The infected man, gay and in his 40's, tested negative for H.I.V. in May 2003, then tested positive last December, health officials said. Investigators believe he may have contracted the virus in October when he engaged in unprotected anal sex with multiple partners while using crystal methamphetamine. By last month, it was clear that three of the four classes of anti-retroviral drugs used against H.I.V. were not working in this case, and the man showed signs of AIDS, including rapid weight loss, a high level of the virus in his bloodstream, and a depleted supply of crucial immune system cells.
Even though the anti-retroviral "cocktail" has extended many lives, some infected people still deteriorate and end up with AIDS, but that process usually takes many years. Doctors say that for a patient to reach that stage in a matter of months is extremely troubling.
AIDS experts and public health officials have long maintained that since the development of anti-retroviral drugs in the 1990's, people have developed a false sense that AIDS no longer poses a significant threat, leading to a rise in unprotected sex. Clear evidence of the trend has been seen in the growing number of cases of sexually transmitted diseases like syphilis, chlamydia, and lymphogranuloma.
In 2003, a survey by New York City's Department of Health and Mental Hygiene found that more than half of city residents with multiple recent sexual partners had not been tested for H.I.V. in the previous 18 months, and 40 percent said that they had not used condoms the last time they had sex. At the time, Dr. Thomas R. Frieden, the city health commissioner, attributed the results to "H.I.V. precaution burnout."
Mayor Michael R. Bloomberg described the failure to take precautions against H.I.V. in stark terms yesterday. "It's just a sin in our society, where we know how it's transmitted from one person to another," he said, "and we should be able to get people to conduct themselves such that they don't catch it themselves, and certainly that they don't infect anybody else."
Unsafe sex practices combined with growing resistance to medications among people with H.I.V., has had officials warning for years about a possible resurgence of AIDS, a fear voiced yesterday by many people across the country as they struggled to make sense of the news out of New York.
Oliver Palan, 19, a gay student at Baruch College, said that he had slept with 10 men recently, and that none of them had wanted to use a condom. "So many people are like, 'It is so much more fun without the condom,' so they prefer to take the risk," he said, noting that he insists on using condoms. Often, he said, partners will try to dissuade him by saying, "I trust you, you should trust me."
Edsel Gonzalez, 30, a business owner in South Beach, the Miami Beach neighborhood filled with nightclubs and restaurants that is popular among gays, said he was "absolutely worried about this."
"It seems like we're moving backwards in the fight against AIDS," Mr. Gonzalez said. "I'm scared for my son and my family - to think that a type of unknown H.I.V. can resist the effects of modern medicine is unsettling."
Yesterday morning at the Big Cup, a popular coffee shop in Chelsea, the customers, most of them gay men, talked about how the fear of AIDS had declined, especially among a younger generation that did not have the searing experience of watching friends die. Some said they feared that a new strain of the disease might have emerged, but none were surprised, given the prevailing attitude. Will Elosei, 37, at the Big Cup coffee house in Chelsea, said the H.I.V. news will make people more paranoid.
"People got so comfortable with the drugs that they have started becoming complacent," said Will Elosei, 37, from Jersey City. Now, he said, "I think people are going to be more paranoid about everything. Hopefully, open sex will not be a common thing like it is right now."
At an H.I.V. treatment center run by the group Housing Works, in East New York, Brooklyn, an H.I.V.-positive woman named Pat, who would not give her last name, said: "The medications gave people a false sense of security. It gave them a sense that they could do things that before were a death sentence."
People who work in H.I.V. treatment and prevention reported a spike in calls from distraught patients Friday and yesterday, some of them with inaccurate or exaggerated information. "I got a call from someone who had heard that there was a new strain of virus that was spreading around, that resulted in an all but instant onset of AIDS and was totally untreatable," said Martin Delaney, founding director of Project Inform, an AIDS advocacy group in San Francisco.
The true significance of Friday's announcement immediately became a topic of heated debate among scientists who study H.I.V. and AIDS. Many of them said it was too soon to say if the single infection in New York was truly something new. Some noted that they had seen the rapid progression of H.I.V. to AIDS and high drug resistance before, though not both in combination. They said that the New York case could indicate more about the vulnerability of the infected man's immune system than about the dangers of the virus in his body.
"We need better characterization of the virus in this man," said Dr. Marcus Conant, a professor at the School of Medicine at the University of California, San Francisco. "What does it look like genetically?"
Yet he, too, voiced a lack of surprise at the possibility that a more dangerous strain had emerged. "All of us have been expecting for some time there would be the multidrug resistance," he said. "This virus has mutated around what we've thrown at it."
Patrick McGovern, executive director of Harlem United Community AIDS Center, said he was unsure what to think, but added, "I don't know this to be a scare-mongering administration, so I would tend to take them pretty seriously."
Even as he announced the detection of the aggressive strain of H.I.V., Dr. Frieden, the city health commissioner, said that more testing was needed before health officials and scientists could be certain about the extent of the threat. But for now, he said, the responsible reaction was to treat it as a real menace and to alert the public.
Yesterday, doctors and counselors who specialize in H.I.V. treatment and prevention were focused on news that the more virulent infection had appeared in a man who used methamphetamine and then had unprotected sex with multiple partners.
For decades, methamphetamine - a powerful and sometimes addictive stimulant also called crystal meth or speed - was found mostly in states in the West. But it has made deep inroads around the country in recent years, and in much of the nation's midsection it has supplanted cocaine and heroin as the biggest drug problem. In recent years, H.I.V. counselors say, sexual marathons, fueled by methamphetamine and other drugs, have become popular among some gay men.
"In the last 12 to 15 months, we've seen a huge increase in meth use among people that are newly tested H.I.V.-positive," Mr. McGovern said. "People become hypersexual when they're using crystal, but crystal by itself can limit your ability to function sexually. So people combine it with something like Viagra, that lets them keep going for hours."
Doctors disagree about the role methamphetamine may play in making users more susceptible to infection, but there is widespread agreement that it lowers inhibitions and can lead to more unprotected frequent sex with multiple partners.
Dennis DeLeon, the president of the Latino Commission on AIDS, said it was common for men using methamphetamine to have sex with 10 to 20 partners in one night. "It is a drug where they just lose count," he said.
Most gay men do not engage in such behavior, nor is it limited to gays. But medical history has shown repeatedly that a small number of infected people can cause a serious health hazard.
With doctors, medical researchers and public health officials now on the lookout for signs of a spreading condition, the true nature of the threat may soon become apparent. Health officials seeking to protect the infected man's privacy have said little about him except that he had been very active sexually - one person briefed on the case said he had had hundreds of sexual partners - raising the prospect that others have been infected with the same strain. If the virus is as dangerous as some health officials fear, similar cases could be expected to crop up soon.
If experts were uncertain how concerned they should be, average citizens were even more so.
At the Housing Works center in Brooklyn, where most of the clients are black, some said they thought a more virulent form of AIDS was old news. Others said they believed it affected only white people, and still others said the entire affair was an overreaction.
Lissa Welchel, 32, a wine broker in Miami, said the more she learned about the strain the more worried she became. "What scares me the most is the rapid progression of this strand," she said. "AIDS is a scary disease in itself, and to think that an unknown strand with such power could be transmissible is a definite alarm for concern."
Still, she said she was unsure how great a threat it was. "I hope that this is just a single case and we don't experience a wide-spread event of people dying from AIDS years before their time," she said.
Reporting for this article was contributed by Jennifer 8. Lee, Johanna Jainchill and Janon Fisher in New York; Perry Athanason in Miami; and Carol Pogash in San Francisco.
Scientists Urge More Study On a Rare Strain of H.I.V.
NY Times
February 13, 2005
By DONALD G. McNEIL Jr. and LAWRENCE K. ALTMAN
On the day following the announcement that a rare strain of the AIDS virus was found in a New York City man, scientists said much work needed to be done to assess just how dangerous the virus is.
In particular, experts said, it needed to be seen whether the same virus could be transmitted as easily to other men, whether it would destroy their immune system as quickly and prove as resistant to anti-retroviral drugs as it did in the New York man.
The virus, experts said, might be less dangerous in someone with a different genetic makeup or less of a drug habit. City health officials said only that they have two people trying to locate the infected man's sexual partners.
Dr. Anthony S. Fauci, a prominent AIDS researcher and head of the National Institute of Allergy and Infectious Diseases, said he had seen cases where two sexual partners had been infected by the same strain and "one does reasonably well, and the other progresses fulminantly" - meaning that his immune system collapses rapidly.
The new virus, experts said, must also be tested in two ways in the lab: it should be added to immune system cells to see if it replicates in them faster than other strains do, and it should be mixed with other strains to see if it attacks immune cells more efficiently.
What is not clear yet, several experts said, was whether the disease had progressed so rapidly because the virus was strong or the patient was weak.
About 1 percent of all people infected are "slow progressors," who take decades to get sick. The reasons are unknown, but some have genetic mutations that disable the receptors on the outside of the CD-4 immune system cells to which the virus attaches.
At the other end of the spectrum will be 1 to 2 percent who are "fast progressors," who develop AIDS - meaning very low numbers of CD-4 cells and opportunistic infections like pneumocystis carinii pneumonia - in months. The average time between infection and AIDS is 7 to 10 years.
The man in New York, who is clearly a fast progressor, has a "dual-tropic" strain of the virus, which means it can attach to two types of receptors, which are nicknamed the R5 and X4 receptors, on the outside of the CD-4 cell.
In the vast majority of people who get infected, said Dr. Robert C. Gallo, a co-discoverer of the AIDS virus, the first infections are attached to the R5 receptors. Only after several years do the X4 receptors kick in, and then the patient's condition often worsens quickly.
In a very small number of patients, the primary infection is on the X4 receptors, and they are often - but not always - fast-progressors.
But such patients are seldom studied, so it is not known why the virus attaches there. "It's probably by chance, or someone whose receptors are more active," Dr. Gallo said. "But it can be the patient, not the virus, that's rare."
Dr. Roger J. Pomerantz, an AIDS specialist at Thomas Jefferson University in Philadelphia who studies interactions between drugs and the virus, said there was some evidence that the infection moves faster in alcohol and heroin abusers.
But he added that little is known about whether amphetamines, which are chemically very different from those other drugs, suppress a person's immune system or affect X4 receptors.
By contrast, Dr. Jeffrey D. Klausner, the director of prevention of sexually transmitted diseases for the San Francisco Department of Public Health, said he thought that amphetamine use could lower CD-4 cell counts and could have contributed to the speed of the New York man's infection.
But that would mean that the amphetamine, not the virus, was to blame.
The patient's virus was also resistant to treatment with three of the four classes of anti-retrovirals.
That is unfortunate, experts said, but hardly unknown: thousands of patients in the United States have viruses with varying degrees of drug resistance.
"Multidrug-resistant H.I.V. has been around for a while, and it's not associated with more rapid disease progress," said Dr. Frederick Hecht, an AIDS specialist at the University of California at San Francisco.
The mutations that make a strain drug-resistant may make it less aggressive than the original strain, several experts said. The health officials who raised the alarm on Friday said they did so because they thought the man was the first they had seen who was resistant to so many drugs and also a fast progressor.
But other experts repeatedly stressed yesterday that it was still too early to tell how rare that condition is or even why it might exist in the New York man.
Dr. Jack A. Dehovitz, a professor of infectious disease at State University of New York Downstate Medical Center in Brooklyn, who was among the public health experts at Friday's announcement, said he was uncomfortable with the expression "super strain."
"We've been dealing with resistant strains from the beginning of the treatment era," he said, acknowledging that the rapid progress in one patient "might be a coincidence."
The point of the public warning, he said was to "encourage the community to do the right thing."
Dr. Roy Gulick, an AIDS specialist at Cornell University's medical school who also joined the city's news conference, conceded, "We certainly don't know that this is a new super strain that's going to spread."
But seeing a drug-using patient with a rapid and resistant strain was an unusual and frightening confluence of factors, he said, "and we need to do a better job of reinforcing public health messages."
Carol Pogash in San Francisco contributed reporting for this article.
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