Important note: Information in this article was accurate in 2005. The state of the art may have changed since the publication date.
Bay Area Reporter - August 11, 2005
Liz Highleyman
This past winter, a New York City man presented with advanced immunosuppression, although he was believed to have been infected with HIV just a few months earlier. His virus was resistant to multiple drugs, dual-tropic (able to use two different types of receptors to enter cells), and had a high replication capacity, leading some experts - and much of the press - to warn about a rapidly progressing superstrain.
Transmission of drug-resistant HIV is not a new phenomenon, and it is well known that due to genetics and other factors, HIV disease progresses at varying rates in different individuals. In this case, experts speculated that the man's use of crystal methamphetamine might have contributed to his weakened immunity.
The New York case was the first public report of HIV that is both dual-tropic and resistant to the three major classes of antiretroviral medications. It later turned out, however, that the man responded to treatment including Sustiva (efavirenz) and T-20 (enfuvirtide or Fuzeon).
AIDS advocates and other experts strongly criticized the New York City researchers and public health officials who announced the case at a February 11 press conference, saying they sounded the alarm prematurely based on a single case before there was enough information to draw conclusions; nevertheless, many took the opportunity to add that the case was a "wake-up call" and a reminder to gay men to practice safer sex.
Details of the case were discussed at an unusual special symposium at the 12th Conference on Retroviruses and Opportunistic Infections in Boston later that month, and were published in the March 19, 2005 issue of The Lancet.
In the months after the case was discovered, researchers analyzed more than 135,000 stored HIV samples in an attempt to find a match for the New York man's strain.
At the recent IAS conference, Dr. Gary Blick of Circle Medical in Norwalk, Connecticut, reported that he had been notified by Quest Diagnostics in San Juan Capistrano that one of his patients harbored a strain of HIV that was 99.5 percent genetically similar to that of the New York man. The New York and the Connecticut patients visually identified each other and said they had unprotected anal sex at a New York City sex club in October 2004.
The so-called Patient Zero is a 52-year-old man who was diagnosed with HIV in 1993. Unlike the New York man, the Connecticut patient has had unremarkable disease progression and his virus has a low replication capacity. Despite having highly drug-resistant HIV, he has responded well to salvage therapy including Sustiva and T-20. "He is not a rapidly progressive patient," Blick said.
In addition, the Connecticut man's partner of 10 years was found to harbor an HIV strain that was a 98.5 percent match to that of the New York man, with whom he also had sex the same evening. Blick suggested that this third man may have been superinfected with his partner's multidrug-resistant HIV, and now appeared to have a recombinant form of the virus.
The IAS report appears to confirm many experts' expectation that the New York City man did not signal a new highly virulent strain of HIV. The rapid progression in this case, Blick suggested, might be due to host factors such as multiple sex partners and heavy drug use.
Some experts have suggested it is possible that the New York man might have been coinfected with two normal strains of HIV at around the same time, rather than a single superstrain.
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