Important note: Information in this article was accurate in 2005. The state of the art may have changed since the publication date.
Chicago Tribune - February 15, 2005
Jeremy Manier, Tribune staff reporter
In 2001 Montaner made news in British Columbia by announcing he and colleagues had identified a potential HIV "superbug" in two newly infected patients. As with the New York case, the Vancouver patients developed AIDS within months after infection and had a virus that was resistant to three anti-HIV drugs.
Yet fears that the Canadian patients heralded a new and dangerous HIV strain were not borne out--a timely lesson, some experts say, given the anxiety surrounding the New York case. Multidrug resistance remains unusual in Vancouver patients several years after Montaner's discovery.
Several researchers and AIDS activists, including Montaner, said Monday they are puzzled by the decision of New York and federal health officials to highlight a single patient without having enough data to know if his case represents a trend or a rare coincidence.
"There's not a lot we can conclude from these isolated cases," said Montaner, chairman of AIDS research at the University of British Columbia, though he adds that such cases are worrisome enough to inspire vigilance and caution among groups at risk for HIV.
Other AIDS experts were more blunt in their criticism of the New York City health department, which announced the case in a high-profile news conference Friday. In interviews then, New York health officials said the case was the first they knew of in which a newly infected patient had both multidrug resistance and rapid onset of AIDS. New York officials said Monday they had not known of the Vancouver cases.
Some researchers said it was also confusing that the health department and officials with the federal Centers for Disease Control and Prevention focused attention on the patient's rapid progression to AIDS--a problem that could have stemmed mostly from the man's genetic susceptibility to the disease.
"I think it's pretty strange that they're making a tempest in a teapot over this," said Dr. Steven Wolinsky, chief of infectious diseases at Northwestern University.
New York's publicizing of the case also was surprising to Dr. Richard Kaslow, a professor of epidemiology at the University of Alabama at Birmingham who has studied how genetic factors affect patients' progression to AIDS.
"It would be best to have a complete picture of the host and the viral characteristics before drawing any early conclusions," Kaslow said.
Although researcher Dr. David Ho is studying the case at New York's Aaron Diamond AIDS Research Center, a spokesman there said he has not concluded yet what caused the patient's rapid progression.
In a health alert sent to doctors Friday, the New York health department said testing indicated the man has an "X4" virus, a variant linked with rapid progression to AIDS. But Kaslow said that alone wouldn't necessarily tell doctors why the patient's disease developed so quickly.
New York officials said Monday the publicity they gave the case was justified to warn physicians and at-risk people of a potentially new problem.
"In public health we feel we have a duty to warn people early," said Sandra Mullin, communications director for the New York City health department.
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