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New epidemic or flawed research?

Debate rages over emergence of HIV 'super strain' in New York

Is it or isn’t it?That is the question AIDS community members and activists, scientists, health professionals and media hacks have been asking for weeks now: has a gay, middle-aged New York City man contracted an HIV “super strain” or not?

The debate has raged ever since the New York City Department of Health and Mental Hygiene (DOH) announced the discovery of a rare and potentially “highly virulent strain of HIV” during a press conference on Feb 11.

The department, led by its health commissioner Dr Thomas Frieden, said it decided to make the announcement after being notified of the potential “super strain” by Drs David Ho and Martin Markowitz of the Aaron Diamond AIDS Research Center in Manhattan, who passed on the partial results of their preliminary investigation into the so-called “super strain.”

According to Frieden, the strain not only is resistant to three of the four licensed classes of anti-retroviral drugs used to suppress the virus, but also appears to have rapidly progressed from initial HIV infection to full-fledged AIDS, perhaps in as little as eight weeks to 12 weeks. The average AIDS onset after HIV infection is about ten years.

What particularly worried the DOH was that the gay man in question had been sexually active after his estimated time of infection (Oct 2004), allegedly engaging in frequent unsafe sexual encounters while under the influence of crystal methamphetamine, until he began to feel ill last November and was diagnosed with HIV in December.

All of these factors combined to make a potential health emergency, Frieden says, so the DOH decided to hold the press conference to alert the general public to the possible dangers the case poses.

“It’s a wake-up call to men who have sex with men, particularly those who may use crystal methamphetamine,” says Frieden in a Feb 11 press release. “We’ve identified this strain of HIV that is difficult or impossible to treat and which appears to progress rapidly to AIDS.”

But skeptics abound whether the NYC case warranted a well-publicized public health announcement. Most notable among them is Dr Robert Gallo, who co-discovered that the HIV virus causes AIDS in 1987.

He says DOH officials may have been unnecessarily alarmed into holding the press conference by the information Ho’s team provided the city, which was still in its preliminary testing stages.

“They wouldn’t do that [hold the press conference], I don’t think, unless they were told there was this new, crazy virus that is worse than any other HIV strain-that we may be having a new epidemic, or a variant of HIV that is much worse,” he says. But they may have accepted that information without understanding enough of the virology involved in HIV/AIDS research and diagnosis, he adds.

Shortly after the DOH announcement, Ho and Frieden were criticized in several press reports for how they handled the case, with some saying the two used the publicity the announcement generated to advance their personal agendas: Ho to shine the spotlight upon himself before the annual AIDS conference held in Boston late last month, and Frieden to stress safer sexual practices among the city’s gay men. Both have denied the accusations.

But Gallo says not only is it “highly, highly unlikely” that this strain is an HIV super virus, he has doubts that the NYC man even has AIDS, as Ho has claimed.

According to Gallo, if the man was in the first two months of infection when he was tested, he could have been in “peak viremia”-the height of the virus presence in the blood of a host-due to his own “individual variation,” which would have “nothing to do with the virus” itself.

Some people can get “a very, very high amount of virus” in their blood for those first five, six weeks after infection, he says. “And the doctors [may] say, ‘Oh, that was AIDS.’ But people have seen that so many times now that they kind of wait and see if [the body] takes care of it.”

To determine if the man actually has AIDS, and is not suffering instead from peak viremia, Gallo says “you’ve got to know when he was infected.”

In addition, Gallo says drug resistant viruses “are all over the place.”

Dr Julio Montaner, professor of medicine and chair of AIDS research at the University of British Columbia, dealt with two drug resistant cases in Vancouver four years ago.

Like the recent case in New York, Montaner says both his patients suffered from a multi-drug resistant (MDR) virus that appeared to rapidly progress into AIDS. After conducting tests on the two patients, Montaner’s team published its findings in the publication “AIDS,” the official journal of the International AIDS Society.

Some have pointed to Montaner’s previously published report and have criticized Ho for touting the supposed uniqueness and newness factor of the NYC case, but Montaner says people should not be so quick to judge what may be a simple oversight on the part of Ho’s team.

“I don’t think it is fair to criticize our colleagues for putting up a warning. All of these things are a matter for concern,” says Montaner over the phone from Vancouver. “Let’s just be clear that HIV is the number one villain here.”

While it is not clear, at least for now, if these three cases are representative of the beginnings of an HIV super virus, Montaner says what is clear is that if the NYC strain proves not to be particularly virulent after all of the media hype that surrounded it, “the wrong message” could be sent to the public.

“If there is no resistant virus, people may think, ‘Oh, I don’t have to be careful, there’s no super virus,” he says. “By default, what we would be saying is, ‘HIV is fine, but multi-drug resistant is not fine.’ Well, any kind of HIV is bad news, and a huge burden to live with-you don’t want to go there.”

He adds that it is important for the community to step up its safer sex practices, or cases like the ones in New York and Vancouver could become more widespread.

“Multi-drug resistance is extremely infrequent at the moment, but the more people practice foolish sex the more frequent this is going to happen,” says Montaner.