Pubdate: Fri, 25 Feb 2005
Source: San Francisco Chronicle (CA)
Section: Page A - 3
Copyright: 2005 Hearst Communications Inc.
Contact:  http://www.sfgate.com/chronicle/
Details: http://www.mapinc.org/media/388
Author: Sabin Russell, Chronicle Medical Writer
Bookmark: http://www.mapinc.org/meth.htm (Methamphetamine)

CONFERENCE QUESTIONS 'SUPER-STRAIN' OF HIV

Experts Unsure If N.Y. Case Is Unique Or A General Threat

Boston -- Two weeks after New York City health officials warned that a 
potent new strain of HIV highly resistant to available drugs may have been 
detected there, experts at the nation's leading scientific conference on 
AIDS were in disagreement whether the presumed new strain represents a 
scientific oddity or a public health menace.

To date, the virus has been spotted only once, in an unidentified 
46-year-old gay man who reported having hundreds of unprotected sexual 
encounters, often under the influence of crystal methamphetamine.

There is no evidence that the virus is readily transmissible, and there is 
also uncertainty over whether the bug detected is really a single, highly 
resistant strain of HIV, or possibly many subtypes of the virus in the same 
patient -- each resistant to some drugs, but not to all.

Dr. David Ho, scientific director and chief executive of the Aaron Diamond 
AIDS Research Center in New York, where the patient was treated, posted 
details of the case and discussed his findings with reporters and at a 
special session devoted to the topic Thursday evening.

Ho created a controversy when his lab turned the data on the new patient 
over to public health authorities, which in turn led to a nationwide alert 
about the possibility of a new strain -- a move some criticized as premature.

"That is a decision that we stand by today," said Ho, before an auditorium 
packed with delegates who skipped previously scheduled sessions of the 12th 
Annual Retrovirus Conference to hear this one.

Ho and the New York City health department are concerned that this case 
uniquely combines two rare but worrisome traits: viral resistance to almost 
all available drugs and the rapid onset of AIDS.

It can take as long as 10 years for HIV to wear down the human immune 
system and cause the symptoms of AIDS, but Ho is convinced the New York 
patient was infected no more than 20 months ago -- and likely as recently 
as October.

The crucial question is whether the aggressive case of AIDS suffered by the 
New York patient is the result of something new about the virus, or is 
specific to the patient due to his genetics or to behavior that made him 
vulnerable.

"I don't think we can readily discern between the two possibilities," Ho said.

He revealed that researchers had already ruled out some of the most common 
genetic traits that leave some people predisposed to an early onset of AIDS 
after infection. But he said tests are still under way on a dozen other 
known traits thought to confer some vulnerability.

Details of the paper show just how sick the man has become: His count of 
infection-fighting CD4 white blood cells had slipped to 28 by mid-January 
- -- while a count of 800 to 1,000 is considered normal. He has rapidly lost 
weight, dropping nearly nine pounds in three weeks, and his level of virus 
has soared to a measure of 700,000 particles per milliliter of blood -- 
indicative of a very robust infection.

Ho, a prominent New York AIDS researcher who is serving as co-chair of the 
conference, has been criticized for making too much of a single case, and 
also has been praised for promptly warning about the potential threat.

Following the presentation, delegates knew more about the case, but also 
learned that more evidence -- and perhaps much more time and research -- 
will be needed before anyone can draw conclusions.

"It's much ado about an anecdote," said longtime AIDS activist Mark Harrington.

Martin Delaney, founder of San Francisco's Project Inform, remained 
skeptical after reading Ho's report, which was printed on a poster 
available to all delegates.

"These kinds of cases have been reported before," Delaney said -- referring 
to a Canadian doctor's observations of two patients with multidrug 
resistant virus and rapid onset of illness, first reported in 2001. "A lot 
of clinicians see this stuff, and they don't call press conferences."

Ho said his poster was presented not to reveal any unexpected or new 
findings about the case, but to satisfy the intense scientific interest in 
details of the case at the meeting here, where 3,900 of the top AIDS 
researchers in the world are congregated.

Details within the report describe a patient who became very sick, very 
quickly, after binges of unprotected sex and methamphetamines. Ho said that 
there is ample evidence that methamphetamine use is associated with 
riskier, unprotected sexual activity -- a phenomenon called disinhibition. 
There is no evidence, he said, that the drug itself makes the immune system 
more vulnerable to infection.

Among the other findings about the case:

- -- The New York patient had his blood tested frequently, five times since 
September 2000, but stopped after May 2003. All those tests were negative.

- -- He became ill in early November 2004, and took another blood test in 
mid-December, which was positive. He had sex with "approximately" 10 
partners from the onset of his illness until the end of December, "when 
sexual activity ceased due to his deteriorating health."

- -- Genetic sequencing of the New York patient's virus has shown it does not 
match any known strain of HIV contained in a massive database of viral 
strains maintained at Los Alamos National Laboratory. Only a few genetic 
changes are necessary, however, to define a new strain.

San Francisco AIDS physician Steven Deeks said in an interview that he 
believes that "host factors" -- traits of the patient rather than the virus 
- -- are almost certainly the cause of his rapid deterioration in the face of 
a multidrug resistant virus. However, he said the case still underscores 
the danger of unsafe sex in an environment populated by a still-dangerous 
virus.

"All the media attention has brought to the forefront what is currently 
driving this epidemic: out-of-control methamphetamine use in young, gay 
men," he said. "We see this in San Francisco. Twenty percent of patients 
with highly resistant HIV are having sex with men known to be HIV negative 
or whose serostatus in unknown."

Dr. Harold Jaffe, who headed the Centers for Disease Control and 
Prevention's AIDS programs during some of the darkest days of the epidemic 
in the 1980s, said there are many unanswered questions about the New York 
patient, such as who infected him, when was he infected and whether he has 
infected others. The biggest question, Jaffe said is why -- more than two 
decades into the epidemic -- some people still practice behaviors that put 
them at high risk of infection.

Jaffe said he doesn't think such cases should be used "to scare people" 
into safer sexual practices, but that it is correct to make them public.

"The important thing is to put out the facts," he said. "If the facts are 
scary, then people will be scared."
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MAP posted-by: Beth