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H.I.V. Strain Adds Urgency to Changes in NY City AIDS Program
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NY Times
February 16, 2005
By MARC SANTORA and LAWRENCE K. ALTMAN
Acting with added urgency after a rare and possibly virulent strain of H.I.V. was detected last week in New York, the city's health department is reorganizing its AIDS program to encourage more aggressive collection of crucial information about the treatment and the spread of the disease, the department's commissioner said yesterday.
The commissioner, Dr. Thomas R. Frieden, said that the department had too little information to deal with the growing problem of H.I.V. resistance to drug treatment.
"We are going to try and do things to stop the epidemic," he said, adding that state law now impedes the collection of information. For example, he said, "I can't tell you how many people are on treatment for H.I.V."
While stressing that concerns about privacy were "supremely important," he said that state law would likely have to be changed to institute one of the measures he considers crucial. That measure would allow the city and the state to collect information about the amount of virus in a patient's blood to better determine how he or she is responding to treatment. The issue is currently being discussed with state officials.
There are now an estimated 50,000 people taking anti-retroviral medication in New York, Dr. Frieden said. "And we really don't have much of a sense of what treatment they are on, whether the treatment is appropriate, how they are doing, whether the viral loads are suppressed, how many of them have drug resistance to one or more classes of anti-retrovirals, whether that number and proportion have increased in recent years," he said.
Despite the complexity of routinely getting such information, it could be done, Dr. Frieden said.
Dr. Guthrie S. Birkhead, director of the New York State Health Department's AIDS Institute, said he discussed the measure with Dr. Frieden and was open to considering changing state law. However, Dr. Birkhead and Dr. Frieden said they recognized that because laboratories do not use a standard format to report test results, collecting the data could prove extremely difficult.
Dr. Frieden said he also wanted the state to require all laboratories across the country that test newly infected New York City residents to report whether they have strains of the virus that respond to medication to improve tracking the disease and to provide feedback to doctors about the best treatment for their patients.
Immediately after the rare H.I.V. strain was reported to the department, Dr. Frieden said he asked the dozen or so laboratories licensed by the state to check their records for any other patients with the same strain of the virus.
Dr. Birkhead said the city and state were currently allowed to collect such data under limited powers granted to prevent the outbreak of a new disease. The state would be open to the idea of testing newly infected H.I.V. patients to see what medication they respond to, he said, if it decided a case was worthy.
Dr. Frieden is seeking certain specific information: of all people on treatment, how many remain on treatment a few months later; what proportion of them return to school or work; what proportion of those stop treatment because of bad reactions; and how many of them die.
More broadly, the city's health officials are trying to fight complacency about the spread and danger of AIDS and to change the way people think about the disease. Concerned that the public and medical providers have come to see the disease as just another chronic condition, Dr. Frieden said that an act as simple as changing the name of the department's AIDS unit was important.
The unit had been called the Bureau of HIV/AIDS Services, and it will now be named the Bureau of HIV/AIDS Prevention and Control.
While proposals to restructure the AIDS bureau have been in the planning stages for months, they gained added urgency after the city announced last week that a strain of H.I.V. had been found that showed resistance to multiple drugs and possibly led to the rapid onset of AIDS in a New York City man, perhaps in as few as two months.
How far the strain has spread is unknown, but investigators are actively trying to track down the infected man's partners. One person briefed on the case said the man slept with hundreds of people in the fall of 2004. So far, investigators have contacted about a dozen people they believe had sexual contact with him.
But Dr. Frieden noted that changes in the program have been studied for more than a year.
Some eighteen months ago the city appointed a commission to study how the health department dealt with HIV and AIDS, and the commission is expected to issue its report this spring.
Dr. Frieden has been criticized recently for issuing a citywide alarm after finding the new strain in just one patient, whose own immune system may have made the strain seem more virulent. But he defended his action, saying the man "has one of the most resistant strains that has been seen" and had unprotected sex with many partners.
Still, Dr. Frieden said that despite his aggressive approach in this case and the proposals for changing the department's approach to AIDS prevention and treatment, patient privacy remained paramount.
"Confidentiality is a core and supremely important concept here," he said.
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