Newsday - Monday, January 31, 2000
Laurie Garrett, Staff Correspondent

One study unveiled yesterday found that highly infectious African strains of the virus have appeared in New York City. Another study found that gay American men increasingly are abandoning safe sex practices, and a third suggests that some forms of birth control may triple a woman's risk of becoming infected.

Most of the 3,000 scientists and doctors gathered here this week are focused on rewards and risks of "the therapeutics arena, which has become quite complex," said Dr. Constance Benson of the University of Colorado, the conference chairwoman. She noted that 14 anti-HIV drugs are now on the market that can be used in hundreds of combinations to control the Human Immunodeficiency Virus.

But from a public-health perspective, despite positive drug developments, "it's kind of hard to declare victory with much of anything in this epidemic," Dr. Stan Lehman of the Centers for Disease Control and Prevention said in an interview.

Based on a national CDC survey, Lehman presented evidence yesterday indicating that concern about HIV infection has plummeted among gay men, sexually active heterosexuals and intravenous drug users, largely because they mistakenly believe that AIDS is no longer a fatal disease.

"A lot of people - close to a third - said they were less concerned," Lehman said, which he suggested "could translate into increased risk behavior and, with that, increased transmission of HIV."

Lehman's survey involved 2,000 men found in gay bars, addiction clinics and treatment centers for sexually transmitted diseases. Nearly one of five respondents said they took more risks in their sexual and drug-use activities in 1999 than in 1998.

At the same time, according to Dr. Sara Beatrice and her staff in the New York City Department of Health, the city is witnessing a surge in African and Asian subtypes of HIV.

Until quite recently, nearly every North American infected with HIV carried the B subtype strain of the virus. But worldwide, B subtype outbreaks have been waning, with the fastest expanding epidemics involving so-called C and F subtypes.

Beatrice's group found that 71.6 percent of all African-born HIV patients in New York City last year carried non-B forms of the virus. Similarly, 74.3 percent of Asian-born HIV patients in the city had non-B forms, and 51.2 percent of those born in Latin America. Overall in the United States, 98.4 percent of all HIV infections last year were sub-type B, the CDC has said.

This is important, Beatrice said in an interview, because the assays used in the United States to measure virus levels in blood are designed to spot the B subtype. Patients who are infected with African and Asian strains of the virus may not be getting accurate viral measurements with those tests.

Additionally, according to Dr. Robin Weiss of the Windeyer Institute in London, researchers think that the C subtype may be more highly infectious than the more common B.

"There are more questions that we don't have answered than we do," Beatrice said of New York City's changing HIV pattern. "We really are in a very primitive state of understanding."

One thing that has been clear is that women are more likely to become infected when sexually exposed to HIV than men if they are taking hormonal birth control or are post-menopausal.

Yesterday, Preston Marx of the Aaron Diamond AIDS Research Center in Manhattan said he thinks he has determined why.

Marx studied HIV vaginal exposure in rhesus monkeys. Five of six monkeys that had progesterone implants under their skin became infected when exposed vaginally just once to a droplet of HIV-contaminated fluid. So did six out of six control animals who had no hormone implants.

But none of the monkeys that had estrogen implants acquired HIV infection, he reported, despite repeated droplet exposures.

Marx thinks vaginal Premarin or other artificial estrogens could protect post-menopausal women against HIV. Conversely, Depo-provera and other progesterone-based birth control "is a cause for concern," he said.

Always watch for outdated information. This article first appeared in 2000. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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