Super HIV
 

This press release was posted yesterday:

http://www.nyc.gov/html/doh/html/pub.../pr016-05.html

Press Release
New York City Department of Health
and Mental Hygiene
Office of Communications
FOR IMMEDIATE RELEASE
CONTACT: Sandra Mullin/Sid Dinsay
Business Hours (212) 788-5290
After Business Hours (212) 764-7667
Friday, February 11, 2005

NEW YORK CITY RESIDENT DIAGNOSED WITH RARE STRAIN OF MULTI-DRUG RESISTANT HIV THAT RAPIDLY PROGRESSES TO AIDS

Highly Virulent Strain Resistant to Three Types of HIV Drugs Is Rare In Patients Not Previously Treated for HIV; Strain Is Also Associated with Rapid Onset of AIDS

Health Dept. Urges At-Risk Groups To Stop Risky Sexual Behavior; Patients Who Are On Treatment For HIV/AIDS And Are Doing Well Do Not Need Susceptibility Testing Unless Advised By Their Physician

------------------------------------------------------------------------

NEW YORK CITY - February 11, 2005 - A highly resistant strain of rapidly progressive human immunodeficiency virus (HIV) has been diagnosed for the first time in a New York City resident who had not previously undergone antiviral drug treatment, according to the Department of Health and Mental Hygiene (DOHMH). The strain of three-class antiretroviral-resistant HIV - or 3-DCR HIV - does not respond to three classes of anti-retroviral medication, and also appears to greatly shorten the interval between HIV infection and the onset of AIDS.

The patient is a male in his mid-40s who reported multiple male sex partners and unprotected anal intercourse, often while using crystal methamphetamine (crystal meth). He was first diagnosed with HIV in December 2004 and appears to have been recently infected. The diagnosis of 3-DCR HIV was made shortly thereafter at the Aaron Diamond AIDS Research Center. Since then, the patient has developed AIDS. DOHMH is counseling and offering HIV testing to those contacts of the patient who have been identified.

While drug resistance is increasingly common among patients who have been treated for HIV, cases of 3-DCR HIV in newly-diagnosed, previously untreated patients are extremely rare, and the combination of this pattern of drug resistance and rapid progression to AIDS may not have been diagnosed previously. Strains of 3-DCR HIV are resistant to three of the four available types of antiviral drugs that are most commonly prescribed: nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, and protease inhibitors. This strain also caused a rapid onset of AIDS, which usually occurs more than ten years after initial infection with HIV. In this patient's case, onset of AIDS appears to have occurred within two to three months, and at most 20 months, after HIV infection.

Health Commissioner Thomas R. Frieden, MD, MPH said, "This case is a wake-up call. First, it's a wake up call to men who have sex with men, particularly those who may use crystal methamphetamine. Not only are we seeing syphilis and a rare sexually transmitted disease - lymphogranuloma venereum - among these men, now we've identified this strain of HIV that is difficult or impossible to treat and which appears to progress rapidly to AIDS. This community successfully reduced its risk of HIV in the 1980s, and it must do so again to stop the devastation of HIV/AIDS and the spread of drug-resistant strains. Second, doctors in New York City must increase HIV prevention counseling, increase HIV testing, obtain drug susceptibility testing for patients testing HIV-positive who have not yet been treated, improve adherence to antiretroviral treatment, and improve notification of partners of HIV-infected patients. Third, the public health community has to improve our monitoring of both HIV treatment and of HIV drug resistance, and we have to implement prevention strategies that work."

The Health Department recently issued a Health Alert to physicians, hospitals and other medical providers asking them to test all previously untreated patients newly diagnosed cases for anti-HIV drug susceptibility. The Department is monitoring laboratories for additional cases of 3-DCR HIV in newly diagnosed persons. DOHMH is also working with New York State to establish a long-term system for monitoring drug resistance in HIV-positive patients who have not yet undergone treatment.

Dr. Frieden added, "Patients who are on treatment for HIV/AIDS and are doing well do not need susceptibility testing unless advised to by their physician."

REMARKS BY MEDICAL AND COMMUNITY LEADERS

Dr. David Ho, CEO and Director of the Aaron Diamond AIDS Research Center, said "This patient's infection with an HIV-1 strain that is not amenable to standard antiretroviral therapy, along with his rapid clinical and immunological deterioration, is alarming. While this remains a single case, it is prudent to closely watch for any additional possible cases while continuing to emphasize the importance of reducing HIV risk behavior."

"The rapidly growing crystal meth epidemic in New York city continues to play a significant role in facilitating the transmission of HIV. In light of the emergence of this virulent new strain, health care providers must be especially vigilant in not only recognizing and diagnosing HIV infection, but also in recognizing the signs and symptoms of crystal methamphetamine use in their patients," said Dr. Antonio Urbina, Medical Director of HIV education and training, at St. Vincent's Catholic Medical Center.

"Callen-Lorde is deeply concerned about this newly identified case of multiple drug resistant HIV," said Jay Laudato, Executive Director of the Callen-Lorde Community Health Center. "We urge all persons, both HIV negative and positive, to only engage in safer sex practices in order to prevent new infections or re-infection. For those persons who don't know their status, we urge HIV testing and obtaining the information and support necessary to reduce their risk for HIV infection. We also ask all gay and bisexual men to become knowledgeable about the dangers of crystal methamphetamine and in particular its relationship to sexual risk taking."

Dr. James Braun, President of the Physicians Research Network, said "We believe that the transmission of treatment-resistant HIV was a disaster waiting to happen, particularly in communities where safer sex is not practiced regularly and in light of people using drugs like crystal meth. All primary care providers in acute care settings need to know how to diagnose HIV in its earliest stages and where to refer people so that new infections are properly worked up and treated."

"HIV prevention is an ongoing process," said Ana Oliveira, Executive Director of Gay Men's Health Crisis. We have to double our efforts and resources to maintain treatment and prevention education for people who are infected as well as for those who are not. New Yorkers must be vigilant and know that infection with resistant strains of HIV can be avoided. People living with HIV can live healthy and satisfying lives by protecting themselves and their partners, regardless of HIV status."

Tokes M. Osubu, Executive Director of Gay Men of African Descent, said, "This is the news we have all been fearing. While the recent advances in HIV treatment have led to the improvement of countless lives, we have always known that many people respond poorly to these therapies and for many others, the side effects are devastating. Continued education about staying safe and avoiding HIV remains our most potent weapon."

Dr. Jay Dobkin, Director of the AIDS Program at Columbia University Medical Center, said, "This case is a striking reminder that the risk of getting infected with HIV has not gone away. In fact, risky behavior may be even more dangerous now since there is a chance of infection with a virus we may not be able to treat."

"This case should drive home the point that substance use can lead to unsafe sex, and unsafe sex can lead to infection with a highly drug-resistant strain of HIV that can be extraordinarily difficult to treat and may cause rapid progression to AIDS," said Roy M. Gulick, MD, Associate Professor of Medicine at Weill Cornell Medical College in Manhattan.

Dr. Jack DeHovitz, Professor at SUNY-Downstate Medical Center said, "This finding supports the need for enhanced availability of HIV testing, as well as preventive interventions, which are effective in reducing subsequent HIV transmission."

Know Your HIV Status

There is an epidemic of HIV and AIDS in New York City: more than 88,000 New Yorkers are known to be living with HIV/AIDS, and an estimated 20,000 more are believed to be living with HIV/AIDS and don't know it.

By knowing your HIV status, you can protect yourself, anyone you are having sex with, and, if you are pregnant or planning pregnancy, your baby. Free and fully confidential STD exams and treatment, as well as confidential or anonymous HIV testing, are available at Health Department clinics throughout New York City. Health insurance, proof of citizenship and/or parental consent are not required to receive these services. Please call 311 or visit http://www.nyc.gov/health for a list of clinics and hours of operation.

###

wow that is really frightening.

i wish people would just be safe when it comes to sex. why risk losing your life for one night? but then again, if you're hard core into crystal meth, i doubt you're thinking too straight or would even care.

although it's only one diagnosed case now, in time this new strain could infect millions of people if it doesn't get stopped at the beginning.

I heard this on the news last night. I remember in 1990 or 1991 when AZT came out before the cocktail, there were reports that this treatment would be good for about a decade or two until a stronger strain of HIV and AIDS developed. I guess this is that stronger strain.

which is another reason why I don't go after one night stands. Can't fight with nature, if it wants to kill you, it will.

Gay male, crystal meth, anal sex, hundreds of partners.

-Rudey

:rolleyes:

The dreaded "atomic c*ck-rot" of legend is here to stay... and in a bad way! :eek:

What's the eye-rolling for? You should check out some statistics sometime. The factors that Rudey listed are universally considered some of the top risk factors for acquiring HIV.

Yeah...but not the only ones. It's just that gay males are the first ones you hear about. Gay males are the most vocal about activism and prevention. HIV affects other communties just as hard.

It just bothers me that the first thing that people think is HIV/AIDS=Gay. Ignorance is deadly too.:(

Not according to CDC statistics. Men who have sex with men are often more than 10 times more likely to be infected with HIV.

Here's a 60 page report by the CDC if you doubt it.

http://www.cdc.gov/hiv/pubs/hivpreva...lTrendsPop.pdf

It's no big shocker that we first hear about someone being infected in this group. That's not ignorant, that's just a fact.

Last I heard is that there are 3 known strains of the virus... Most Americans and Europeans have strain A or B (I think, but have not read on the subject lately). Strain C is localized in Africa and some parts of Southeast Asia.

As far as a resistant strain of any of these viruses, it does not suprise me... The main culprit for mutating HIV RNA diploid strain is a highly unfaithful reverse transcriptase--no telling what crystal meth does to the very function of this protein...

Either way, the virus still enters into the CD4+ cells the same way and most of the cocktails only deal with AFTER HIV has entered the cell...

There are some drugs that do work on "entrance" but they are being considered the "vaccines"...

The problems is the very protein that is the "key" for entrance, is what gets changed every time the mutated reverse transcriptase fails to make this protein correctly--gp130 (they have other proteins that are involved, but I don't know them at this time).

Vaccination against HIV will be revolutionary in our current understanding of immunology--that's almost a guarentee from me... And it will be very unique--different from what has been done in the past...

But I NEVER get a straight answer from ANY scientist when I ask this question:

How come when someone has been diagnosed with AIDS and they do get some level of treatment, how come they don't also come down with all the secondary infections that they have been vaccinated against??? Like DPT, Measles, mumps, Rubella, Polio? Why? Should those bad ass illnesses crop up too?

NEVER heard a satifactory answer, YET...

I'm still waiting...

I don't understand. :(

Listen. I don't care if you are too ignorant to read. If that is deadly for you, then perhaps you should stop.

The strain was identified in a patient with all those habits. I haven't had unprotected sex with 400 gay partners while on crystal meth. This doesn't apply to me.

Forgive me for not weeping over a junky gay slut. Now go and eat your cereal and worry about whatever else you'd like.

-Rudey

Hey Kevin you too should go dope up and have marathon unprotected sex sessions and have somewhere around 400 partners and then expect the world to protect you from STDs.

-Rudey

I'm told that it's the American way.

I think I'll pass.

The statistics are the statistics, not ignorance. Take a look at the report.

Right. And it's not even just about being gay. Who has 400 sexual partners to begin with? Does this guy think he's a rock star like my man Freddy?

http://folk.uio.no/hanakrem/music/jpgs/queen3.jpg

-Rudey

spreading
 

http://www.365gay.com/newscon05/02/021505calHIV.htm

(San Diego, California) Health officials say that a rare strain of HIV that is resistant to most AIDS treatments may have struck the west coast.

In a hastily arranged news conference late Monday afternoon, San Diego County public health officer Nancy Bowen said that the strain may have infected a San Diego man.

"[His] HIV has a similar molecular makeup as the patient in New York City," Bowen told reporters.

The man tested positive for the rare HIV strain last fall, Bowen said, after his health provider sent a blood sample to ViroLogic, an HIV typing reference laboratory in Northern California.

Bowen said that even though the strain resists treatment health authorities in the county were not alarmed until last week when New York City's health department released details about a similar case. (story)

After the New York disclosure health departments across the country began to check for similarities.

On Sunday NYC officials said that two more possible cases are being investigated.

In Boston, on Monday, health officials said they are several similar cases over the past few years. (story)

But, it still is not known if all of these cases are linked, indicating a new virulent strain of HIV is spreading across the country. Tests to determine that are underway and it could take a week or more for the results to be known.

In the meantime, Bowen urged calm.

"I don't think it will do anybody any good to get panicked about this," she said.

The New York patient who sparked the nationwide alert is described as a male in his mid-40s who reported multiple male sex partners and unprotected anal intercourse, often while using crystal meth.

Health authorities are trying to track down those partners.

But, in San Diego, Bowen said that the identity of the suspected case there is not known. The reference lab is trying to find his doctor but if the man were tested anonymously, where a code rather than a name is used, it may be impossible to find him Bowen said.

Meanwhile, health officials in Trinidad believe that a man with HIV in Port-of-Spain is also infected with the suspected super strain.

While drug resistance is increasingly common among patients who have been treated for HIV, cases of 3-DCR HIV in newly-diagnosed, previously untreated patients are extremely rare.

This strain also causes a rapid onset of AIDS. Usually full blown AIDS occurs more than ten years after initial infection with HIV. In the original New York patient's case, the onset of AIDS appears to have occurred within two to three months.

scary, very very scary.

Okay from what I understand...
 

The strains are slightly mutated... But no more virulent than before...

It's the people practicing unprotected sex with multiple partners in addition to drug addiction that causes a severely depressed immune system...

So, folks, if you already starting off with a bad immune system and prone to getting insanity, then getting this "mutant HIV" strain is gonna make matters worse...

Also there are folks who are rapid responders to HIV infection... Such as 3-4 months coming down with full blown AIDS symptoms compared to those folks that are slow responders--like 6 months to beyond a year...

Dr. Gallo and others in the field think that it is the way the immune system responds to cause inflammation (natural immunity) rather than the standard antibody response with a cytotoxic T cell response (acquired immunity--i.e. T-cells and B-cells)...

An inflammatory response (i.e. swelling) is activated by many illicit drugs... Especially Crystal Meth... So, add HIV up into the mix... And you've got a case for disaster...

The doctors also think that dudes could have been infected by 2 different strains of the virus that attack at two different functions on the CD4+ T cells... One kills the T cell receptor response, the other kills the signal transduction response... Which means the the CD4+ T cells cannot tell the other acquired immune cells what to do... But for some reason, antigens from the alpha-MHC receptors II on macrophages and B-cells still get presented to the CD4+ T cells... Go figure...

Here is evolution for you... And it won't be televised...

Also, to add...
 

Think about folks... Especially for our new Med Students...

Dude walks in complaining of a severe flu like symptoms, he tests positive for drug use and has scaring on his backside... He as some blood coming out of one or two of his orifaces and a simple blood test looking on the scope shows that there is increased immune cells around--especially tons of leukocytes, but no lymphocytes... There is huge swellings around all his lymph nodes and they are abcessed (soft--I think--I'm not a physician)... But these are what physicians, PA's and nurses look for...

A trained healthcare provider then asks him if he has had unprotected sex within the last year... And patient says yes. And maybe ask if the number was over 5... Then the referring provider will ask the patient if he would like to take an AIDS test... Patient will say yea or nay... If patient agrees, then blood is drawn and sent out... If patient says nay, then treatment for the severe flu like symptoms with all the pus filled lymph nodes and bleeding out of orifaces will not get treated without the test...

That's insurance and skyrocketting healthcare costs for you...

definitely very scary :(