Bay Windows - February 17, 2005
Ethan Jacobs, ejacobs@baywindows.com.

Yet local health officials and HIV/AIDS advocates have expressed skepticism about the news coming out of New York.

"I don't think there's anything really new in what was reported in New York," said Dr. Stephen Boswell, executive director of Fenway Community Health. He said without further research there is no way to prove that this particular strain of the virus led to the rapid onset of AIDS. While most patients develop AIDS about 10 years after being infected in the absence of treatment, some people do so at a much faster or slower rate for reasons that may have nothing to do with the virus itself.

"There are some people who live with the virus without any treatment for very long periods of time for many different reasons, some related to the virus, some related to the individual's own immune system, and so there is variability in any of these situations," said Boswell.

One of the researchers who joined Frieden in announcing the alleged new strain, Dr. David Ho, CEO and director of the Aaron Diamond Research Center, has more recently cast doubt on the theory that the strain causes rapid deterioration. Aaron Diamond Research Center is currently analyzing the allegedly more virulent form of HIV found in the New York patient, as well as two other potential instances of the same strain. In a Feb. 14 interview with the Times, Ho explained that even if researchers determine that the strains are the same, they have no way of knowing if that particular strain is responsible for the New York patient's swift deterioration.

"It could be that the man is genetically prone to have a rapid progression," Ho told the Times. A spokesperson for Aaron Diamond Research Center said Ho was unavailable for comment before Bay Windows went to press.

Boswell said that the issues around drug resistant strains of HIV were also old news to people working in the field.

"We've also known that drug resistant virus is increasingly being seen out in the community, including some highly resistant virus," Boswell explained.

Boswell said of patients at the Fenway newly diagnosed with HIV, about one in 10 has a virus that is resistant to at least one of the major classes of AIDS drugs, and some have virus that is resistant to multiple classes of drugs. As the virus comes in contact with various antiretroviral drugs, it has the chance to become more resistant, particularly when the person infected with HIV fails to adhere to his drug regimen.

Resistance to HIV drugs has been on the radar screen long enough that the Massachusetts Department of Public Health is two months into an initiative to keep track of the number of patients across the state newly infected by drug-resistant forms of HIV. Dr. Alfred DeMaria, assistant commissioner of DPH's Bureau of Communicable Disease Control, said the prospect of a drug resistant virus is not a new fear but an old one.

"It's something that, it can't be a new concern because we should have been and we have been concerned about it for a long time. So the key here is to reduce transmission so people don't acquire these infections whether they're susceptible to the antivirals or not," said DeMaria.

The DOHMH press conference gave every indication that the case was in fact a new concern. Frieden called the case a "wake-up call" to the gay male community to renew their commitment to halting the spread of HIV.

"This community successfully reduced its risk of HIV in the 1980s, and it must do so again to stop the devastation of HIV/AIDS and the spread of drug-resistant strains," Frieden said in a statement. He also urged public health officials and providers to step up prevention and treatment efforts and to monitor drug resistant strains. The Times reported Feb. 16 that in the days since the press conference Frieden called for changes to the state's AIDS policies, including passing legislation to allow the city and state to collect information on the amount of virus in patients' bloodstreams to determine how they are responding to treatment. He also called for all laboratories testing New York residents to test virus samples for susceptibility to different AIDS drugs.

A spokesperson for DOHMH told Bay Windows Frieden was unavailable for comment before the paper went to press.

Frieden was joined at the press conference by representatives of several community-based organizations, including Ana Oliveira, executive director of Gay Men's Health Crisis. Oliveira said that regardless of the outcome of the debates about whether the New York case represents a more aggressive form of HIV, the case allows advocates to draw attention to some of the more pressing concerns around the state of the HIV epidemic: crystal meth addiction, unsafe sex and the incompleteness of the medication regimens available for people with HIV.

"One thing that it does is it brings together in full focus all these issues represented in one case," said Oliveira.

Locally, AIDS Action has taken a similarly pragmatist approach to the publicity around the New York case, using it as an occasion to make a strong plea to people addicted to crystal meth to seek out treatment.

"Frankly I might take a slightly different view than some other folks on this and say I think the publicity actually is fine and that it's appropriate for us to take a moment and say we need to respond to what crystal meth is doing to gay men and take a moment to think about how the community can be supportive... If this case brings some people into treatment or to care then that's a really good thing," said Sophie Godley, AIDS Action's director of prevention and education.

Andrew Sullivan, whose 1996 New York Times magazine article "When Plagues End" documented the moment when the public learned of the success of antiretroviral drugs in prolonging the lives of many people with HIV, argued that crystal meth, rather than an alleged supervirus, should be the gay community's primary focus. "Whatever this turns out to be, the meth crisis is a real and present danger... We have to remind people that meth is lethal - to mental and physical health," said Sullivan, who is HIV positive. "But we should also keep calm and focus on the science and what it tells us about HIV. Scare stories can do good but they can also do harm if eventually discredited."

Some health officials and advocates are worried that the press reports around the New York case, with their description of a gay man as a drug-addicted disease carrier, may do more harm than good.

"I do have concerns about the ways that gay men's sexual behavior, issues around substance use and abuse, and Internet use has all been wrapped up with the description of this case," said Kevin Cranston, director of DPH's HIV/AIDS Bureau. "While it's important to know a lot of detail about any individual case in order to understand their risk background, I think this has become, frankly it's been turned into a scare tactic around some aspects of behavior in the gay male community, and I'm concerned about it further stigmatizing gay men and characterizing them in ways that are simply pejorative and not engaging around public health issues... I think we can have intelligent and informed conversations about both substance use and abuse and ongoing sexual risk taking without collapsing it into a characterization of gay men in general."

He said he hoped there would be more research to find out whether there were more cases involving the same drug resistant strain that progressed as rapidly as the case cited by New York health officials.

Former Boston City Councilor David Scondras, who heads up the Boston-based AIDS advocacy group Search for a Cure, said he worries that if no "supervirus" materializes after all the publicity, it will only make people more complacent about HIV. He argued that stories about aggressive drug resistant forms of HIV have appeared before, but the threats of an unstoppable strain of HIV have never materialized.

Scondras pointed to a Vancouver case in 2001 publicized by the Centers for Disease Control and Prevention (CDC) in which six people were infected with a strain of HIV that was resistant to three classes of drugs. Two of those people deteriorated rapidly months after their diagnosis. Echoing the language of the recent coverage in the Times, an August 2001 CDC news digest on the Vancouver case says the head official investigating the strain, Dr. Julio Montaner, "fears that the two individuals could be the beginning of the spread of an evolved multi-drug resistant 'superbug' virus." No such "superbug" was ever found.

The CDC has been involved in publicizing the most recent case, transmitting information from DOHMH to HIV and STD directors around the country. Scondras criticized the CDC and DOHMH for raising awareness about the case when the evidence of a "supervirus" is lacking.

"It does a real disservice to society to cry wolf because eventually people like you and me stop paying attention to it," said Scondras.

Yet Dr. Ronald Valdiserri, deputy director of the CDC's National Center for HIV, STD and TB Prevention, said the CDC and New York health officials have worked to publicize a potential health threat without causing undue alarm.

"I think the CDC position is that this is a single case, it's not a cause for panic, but we are concerned about the reports of this strain, the combination of broad resistance with what appears to be a rapid clinical course," said Valdiserri. "But it's just a single case at this point in time."

Ethan Jacobs is a staff writer at Bay Windows.

050217
BY050201

Always watch for outdated information. This article first appeared in 2005. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2005. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .