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HIV super strain revisited.

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. The case was further complicated by the fact that John was not following his HIV treatment regimen very closely. This could have led to mutations which made his strain of the virus even more drug-resistant. For years, researchers have thought that HIV reinfection, or "superinfection," as it is sometimes called, can happen as a result of unprotected sex between 2 HIV-infected people. Simply put, superinfection occurs when a person with HIV gets infected a second time with a different strain of the virus while having unprotected sex or sharing needles with another HIV-infected person. Over time, the new strain will flourish in the body, often making a person's once successful treatment useless and leading to a high viral load and a weakened immune system.

Here is what we now know. It appears that John had been suffering from a very serious case of AIDS, even though he had been taking HIV drugs for many years. This suggests that the strain of HIV that he had was probably quite strong and multi-drug resistant. NYC reportedly engaged in unprotected anal intercourse with both John and Bob, despite knowing their HIV status. All 3 individuals reported using methamphetamine drugs during the night in question.

What does this tell us about the NYC case? His rapid disease progression was not caused by a "superbug" that was mutating and growing inside of his body, making him develop AIDS in a matter of months. It came about because he was "superinfected" during unsafe sex with 2 people who were drug-resistant. The use of illegal drugs didn't help--it probably made his immune system a little weaker and made it easier for superinfection to happen. All of the panic over a superbug could have been explained sooner if anyone had looked into NYC's sexual contacts during the first few months after he became sick.

Although the initial fears of a multidrug-resistant strain of HIV spreading rapidly through sex were exaggerated, this case raises a red flag about the dangers of transmitting a drug-resistant strain of HIV--or superinfecting--an HIV+ partner. There have been other reports over the years of superinfection and the potential for rapid disease progression in early HIV infection. Health-care providers who counsel HIV-infected patients now need to be sure that patients understand that getting a drug-resistant strain of HIV through unprotected sex is possible.

In the end, this case is important for a few reasons. First, it illustrates the public health implications of unsafe sex between HIV+ people--the possibility of HIV becoming more and more resistant to drugs is real and growing. Second, it highlights the need for more research to understand just how risky superinfection can be and how it could be controlled or treated. Third, it emphasizes the need to figure out what health conditions or behavioral factors might predict whether or not a person is likely to be superinfected. And finally, it reminds us that we can't take everything we see in the media at face value. Too often, things get blown out of proportion in the rush to be the first to get a story out. It is always best to wait for scientific reports, especially when it comes to health concerns.
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Copyright 2007 Gale, Cengage Learning. All rights reserved.

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Title Annotation:IN THE NEWS
Publication:HIV Treatment: ALERTS!
Date:Jun 1, 2007
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