Important note: Information in this article was accurate in 1998. The state of the art may have changed since the publication date.
Important note: Information in this article was accurate in 1998. The state of the art may have changed since the publication date.
Reuters NewMedia, Inc.; Wednesday July 1 10:56 AM EDT
Patricia Reaney
Dr Frederick Hecht of the University of California and San Francisco General Hospital told the 12th World AIDS Conference Wednesday the middle-aged man was infected with HIV that is resistant to six of the 11 marketed anti-retroviral drugs, including protease inhibitors.
"It is an important warning sign but I don't think people should be panicking," Hecht told Reuters in an interview.
"It is a wake-up call that we need to keep focusing on prevention and need to monitor the transmission of these strains."
HIV strains resistant to an older and less potent class of drugs known as reverse transcriptase inhibitors have been reported before but this is the first time a virus resistant to protease inhibitors (PI) is known to have been passed on.
"Protease inhibitors are the cornerstone of our HIV therapy," said Hecht. "People had hoped that PIs would be significant enough to make it difficult or impossible for the virus to be transmitted."
The case brings home the importance of monitoring to see how frequently resistant strains are transmitted from person to person.
If it is common, Hecht believes there may have to be changes in clinical practices which may include testing all newly infected patients to see whether they have a drug-resistant strain of the virus.
Multiple mutation of the HIV virus makes it resistant to protease inhibitors. Scientists thought these mutations would make it more difficult for the virus to reproduce, lessening the likelihood of transmission between people.
The case also emphasizes the importance of prevention because the multi-drug resistant HIV is believed to have been transmitted through unprotected anal intercourse.
The infected homosexual man was taking part in a study, reported in the New England Journal of Medicine, to determine the prevalence of anti-retroviral drug resistance in recently infected people who had never been treated before.
The man told Hecht and his team of researchers from the university, ViroLogic Inc and the U.S. Centers for Disease Control and Prevention that his only risk encounter was unprotected anal intercourse six months earlier.
He said his partner had withdrawn before ejaculation, which Hecht said was a practice many in the gay community thought was low risk.
The researchers found the partner was diagnosed with HIV in 1990 and had been sporadically treated with nine anti-retroviral drugs, including reverse transcriptase inhibitors and protease inhibitors.
Interruptions in the partner's treatment and non-compliance with the complicated drug programme probably contributed to the development of the resistant strain. "This study shows that we can do more harm than good if we don't help patients take their medications correctly," Margaret Chesney of the University of California at San Francisco said in a statement.
"The bottom line is that helping patients stick to these difficult regimes is as important as the drugs themselves."
An analysis of the man's virus showed it was resistant to two reverse transcriptase inhibitors and all four marketed protease inhibitors. Hecht said because of the resistance, typical drug combinations were not working very well for the patient but he said other treatment options were still open.
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