A scare or some-thing to be scared about? News from New York about a man diagnosed with a new drug-resistant strain of HIV that progresses rapidly into AIDS has left gay men, particularly those who use recreational drugs, wondering if the stakes have changed.
On Feb 11, the New York City Department Of Health And Mental Hygiene issued an alert to all hospitals and doctors in the city to test all newly detected HIV cases for an apparently rare strain that had shown up in an unnamed man in his mid-40s.
The man is said to have engaged in unprotected sex with multiple men. Increasing the hysteria around the case, the man says he was also using crystal meth, a drug which has become a hot-button issue across North America because of its toxicity, addictive qualities and its perceived connection to unsafe sex.
The HIV strain is resistant to three of four classes of drugs used to treat HIV/AIDS, and progressed to AIDS within months. After HIV infection, the average progression to AIDS is 10 years if the person has treatment.
“I don’t think the evidence is really clear. There have always been fast progressors,” says Jane Greer, a counsellor for the Hassle Free Clinic. “Whether it’s a super-strain, based on one case, it’s hard to say. There’s no question that this is alarming; it is. Especially if it is combined with drug resistance.”
However, there has been continuing debate among medical experts, researchers and HIV/AIDS advocates as to whether an alert was needed, considering the strain appears to be isolated to one man. The rapid onset of AIDS may have more to do with his own physiology and history, some medical researchers say.
“We can’t really comment on one case,” says Greer. “Was it his crystal meth use? Was it just a bad immune system?”
Jeff Sheehy from the Center For AIDS Prevention Studies at the University Of California, San Francisco says they see about two or three percent of people who rapidly progress from HIV to AIDS, thought to be due to weakened immune systems. Sheehy says it is known that crystal meth does considerable damage to the body and believes it could be a big factor in the New York situation.
“I think it’s odd that they are calling it a new strain. It doesn’t seem to be progressing to others,” he says.
Dr Julio Montaner, director of the BC Centre For Excellence In HIV/AIDS, has said in interviews with both the Washington Post and Chicago Tribune that he was surprised by the alert. Montaner came upon two similar cases in 2001 in Canada and believed that he and his colleagues had discovered a superbug, which has the same symptoms the man in New York is exhibiting. Both of these failed to show an increased health risk and turned out to be isolated incidents, says Montaner.
“The link being made in the media is a link between fast progression and crystal meth, but this is unclear as far as we know,” says Greer. “I don’t want to alarm the community. It’s not new that drug use can lead to more unsafe sex.”
The concern about drug-resistant strains raises questions about an increased use of some drugs as a kind of day-after treatment, called Post Exposure Prophylaxis (PEP), which reduces the risk of HIV after a risky incident. That’s because drug resistance strains often occur because of failure to complete a course of medication. The misuse of PEP drug therapies is one possible way a person may develop a drug resistant strain of HIV.
The Toronto General Hospital Immunodeficiency Clinic states that another reason that resistant strains occur is because medications are not taken regularly and the level of drug in the blood can become too low to effectively stop the virus from multiplying and this gives the virus a chance to mutate.
“As far as we know there have been no new strains here,” says Greer. “The drug-resistant strains have been around for a long while. So that’s not news.”