AIDS frenzy engulfed New York City when health officials and leading researchers breathlessly announced at a Feb. 11 news conference that they had identified a single patient infected with multiple drug resistant HIV that had rapidly progressed to full-blown AIDS over what was believed to be only a few months.
The New York Times fanned the flames with ominous headlines in blanket coverage of three articles the next day, and a drumbeat of stories over the ensuing days. It raised the specter of a reemerging epidemic that mirrored the early days when HIV was not treatable.
Behind this example of science by press conference, not peer review, were amazingly few clearly established facts, a plethora of unanswered questions, and rampant speculation.
NYC health commissioner Thomas R. Frieden said a gay man in his mid-40s was diagnosed in December 2004 with a strain of HIV that is resistant to drugs in all three classes of therapy that make up most antiretroviral regimens. His T-cells fell rapidly and he was diagnosed with AIDS in January.
The man acknowledged using crystal methamphetamine and to having unprotected receptive anal sex with hundreds of partners, often while taking meth. He had previously tested negative for HIV and officials believe that he became infected some time in October.
'This is a wake-up call,' Frieden said. 'First, it's a wake up call to men who have sex with men, particularly those who may use crystal methamphetamine.'
Renowned AIDS researcher David Ho called the combination of resistant virus and rapid progression 'a scary phenomenon.'
The health department issued an alert to physicians to test all newly diagnosed HIV patients for drug resistance and to choose the therapeutic regimen accordingly. It is a practice that many experienced HIV docs have been following for years.
Not everyone jumped on the hysteria bandwagon. 'My guess is that this is much ado about nothing,' said researcher Robert Gallo, who was one of the first to isolate and identify HIV. 'Though it's prudent to follow, I don't think it's necessary to issue a warning or alert the press.'
'There is no reason for a public national release of information prior to the careful analysis of what actually is going on,' said Boston AIDS advocate David Scondras.
In light of widely ballyhooed fears that an 'epidemic' of syphilis among gay men might lead to a resurgence of new HIV infections—which proved false when the numbers of new HIV diagnoses in San Francisco dropped last year—'the CDC et al have no credibility and our continually traumatized community will opt for skepticism over belief even when a real threat occurs,' Scondras said.
'The history of the AIDS epidemic has taught us that misinformation spreads more quickly than the virus itself,' said Julie David, executive director of the New York-based Community HIV/AIDS Mobilization Project ( CHAMP ) .
'We urge all public and community health providers and the media to clarify the facts of this case, and to direct resources towards a comprehensive HIV prevention effort that confronts, rather than encourages, stigmatization of people at risk of, or living with HIV.'
Untreated HIV takes about a decade to advance from initial infection to an AIDS diagnosis in most individuals. But the overall course of disease progression is a bell curve; at one end are a small group of people known as slow progressors and at the other are a small group of rapid progressors.
The scientific literature has many examples of individuals who have died within about six months of becoming infected with HIV.
Researchers have identified genetic differences as an explanation for some of these differences in the course of disease. Other contributing factors include coinfection with other diseases and substance abuse that may damage the immune system.
The emergence of drug resistance is an issue with every infectious disease, which increases with time. Susan Little, a researcher at the University of California San Diego, leads an ongoing effort to monitor the transmission of drug-resistant HIV in the U.S. She has found that rates vary between 5 and 20 percent, depending on the city.
Resistance to a single class of drug is most common. But resistance to all three classes of anti-HIV drugs has been seen before and those numbers are creeping upward.
Many questions remain concerning the NYC patient. Did his disease progress so rapidly because there is something unique about his virus? Or were there genetic and/or environmental factors that made him particularly vulnerable to HIV, whether it was a drug resistant variety or not?
If it is the virus that is uniquely aggressive, then heightened public health concern is justified. If it is the person that was uniquely vulnerable to the virus, the public health issues are more limited. Those questions clearly need to be answered.
But regardless of the outcome, this serves as a reminder of the need to be smart and safe when it comes to sexual activity.
