Fridae

A man in New York City has been diagnosed with a highly drug resistant strain of HIV that progresses rapidly to AIDS, the Department of Health and Mental Hygiene (DOHMH) announced on February 11. The strain is resistant to three classes of anti-retroviral medications, and the man reported having unprotected anal sex with several sex partners while using the drug crystal methamphetamine.

"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 recognising and diagnosing HIV infection, but also in recognising 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.

After getting diagnosed with HIV in December 2004, the Aaron Diamond AIDS Research Center diagnosed this particular strain called 3-DCR HIV. It's not uncommon for patients who've previously been diagnosed with HIV who've undergone antiviral treatment to experience drug resistance, however according to the DOHMH, cases of 3-DCR HIV in newly-diagnosed, previously untreated patients are extremely rare. In addition, this particular strain causes a rapid progression of HIV to AIDS.

"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," said health commissioner Thomas R. Frieden, MD, MPH. He said syphilis cases and the rare STD lymphogranuloma venereum (LGV) have also been diagnosed among men using crystal.

Frieden says doctors in New York City need to increase HIV testing and counseling. "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."

Physicians, hospitals and other healthcare providers have been asked to test newly diagnosed patients with no prior antiviral treatment for drug resistance. "Patients who are on treatment for HIV/AIDS and are doing well do not need susceptibility testing unless advised to by their physician," says Frieden.

"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," said Dr. James Braun, President of the Physicians Research Network. "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."

Fast onset
The unidentified New York man had reportedly gone for AIDS tests frequently over the years and tested negatively until December, when he tested positive for the virus, Frieden said. He is believed to have become infected in October.
"In this patient's case, onset of AIDS appears to have occurred within two or three months and at most 20 months after HIV infection," Frieden said. The patient has symptoms usually associated "with someone who has very advanced disease," he said.

The normal time of progression from infection to full-blown AIDS in an untreated patient is about nine years, with death following within 18 months, said Karlie Stanton, a spokeswoman for the CDC in Atlanta. For someone treated with anti-viral drugs, the average progression to disease from infection is 11 years, with death occurring within an average six years, Stanton said.

In the mean time, New York health officials are urgently trying to trace other men who may also be infected with the unique strain, and have alerted hospitals and doctors to test every new case of HIV. Gay activists, AIDS prevention workers and the gay community in New York have renewed their commitment to battle against the disease advocating education, prevention efforts and free condoms. Although the number of AIDS-related deaths has plummeted since the introduction of a more potent class of drugs in the mid-90's, the rate of new infections has remained unchanged at about 40,000 cases a year, frustrating many advocates.