Important note: Information in this article was accurate in 1996. The state of the art may have changed since the publication date.
The Associated Press Monday, October 7, 1996 5:53 pm EDT
Lauran Neergaard, Associated Press Writer
Doctors here weren't too worried in 1994 when France first sounded the alarm that an exotic, hard-to-diagnose strain of AIDS was spreading. Then doctors found the first U.S. case in July.
Then last month, scientists uncovered a second U.S. resident infected with this rare type of HIV, named Group O. Meantime, in interviews last week, researchers said they also are investigating a small cluster of New Yorkers with signs of still different AIDS strains never before seen in this country.
"We will now treat these problems as a global village: A case anywhere is a case here, and we will move more quickly" to battle them, said Dr. Jay Epstein, the Food and Drug Administration's blood chief.
AIDS symptoms appear similar worldwide even though the HIV virus is genetically different from country to country. Tests to detect HIV are designed to recognize a region's most common strains. The concern is whether they'll also catch any rare foreign strains.
Take the HIV type named Group O, thought to lurk only in West Africa until a woman in France was diagnosed in 1994. Doctors didn't find the first U.S. case until July, a Los Angeles woman. Her infection had gone undiagnosed by routine AIDS tests, which miss Group O once in every five cases.
Late last month, Abbott Laboratories filed an FDA application to sell the nation's first upgraded AIDS test designed to better catch Group O infections -- just as federal health officials discovered a second Group O case, this one in Maryland.
Both Group O patients found in the United States apparently were infected in their native West Africa, said Dr. Patrick Sullivan of the Centers for Disease Control and Prevention. He is testing dozens of high-risk patients to determine how prevalent the strain is.
More disturbing, the CDC is investigating whether patients in the Bronx borough of New York City caught other foreign strains of HIV while in this country -- not before immigrating here or while traveling abroad.
The CDC genetically tested 43 newly diagnosed AIDS patients from Bronx-Lebanon Hospital Center last spring. Eight patients, an unexpectedly high 19 percent of those tested, had strains different from the subtype B that is responsible for North America's AIDS epidemic.
Preliminary test results indicate six patients have HIV subtypes A or C normally found in Africa, said CDC epidemiologist Dr. Kathleen Irwin. One has a Thailand version of subtype B never before found in a U.S. resident, and the eighth patient has a strain so unique the CDC's tests haven't yet recognized it, said Irwin, who is finishing more sophisticated research to confirm the results.
At least one of the patients, who was born in the United States and has never traveled abroad, had to have caught the foreign strain here, Irwin said. The CDC is trying to trace the infection through the sexual partners.
"The two A's at least had been recently practicing unprotected sex, so there is the possibility of transmission" of foreign strains to other Americans, Irwin said.
Can the AIDS tests used to ensure a safe blood supply keep pace with such diversity?
Standard AIDS tests did diagnose all the Bronx patients, and the FDA hopes to have a better Group O test approved within a year -- even though doctors emphasize that Group O is very rare and the people at highest risk are immigrants whose blood donations are already restricted.
Still, the Group O scare persuaded government scientists to search out samples of the world's known HIV strains to create what CDC epidemiologist Dr. Dale Hu calls a "revolving library" that he will use to check the effectiveness of every U.S. AIDS test.
And the CDC is tracking down AIDS patients known to have immigrated from developing countries to see whether other unknown strains are here.
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