United Press International - July 26, 2005
Ed Susman

Public-health officials in New York City issued a warning because the patient apparently had developed a virulent form of HIV -- the organism that causes AIDS -- that was resistant to virtually all drugs and caused a rapid destruction of the man's immune system.

The original source of the infection is a patient in Connecticut who infected the New York man during anonymous rectal intercourse at a sex club in the city on Oct. 22, 2004. Within three months, the New York man was diagnosed with HIV, and his CD4 blood-cell count -- a marker of the health of his immune system -- had been reduced to double digits. A CD4 count above 500 is considered normal for healthy individuals.

Dr. Gary Blick, a private-practice physician in Norwalk, Conn., reported that his patient, identified as CT01, is the so-called "Patient Zero" -- the source of the New York man's infection.

The new HIV strain appeared to be multi-drug resistant, but Blick said the alarm may have been overblown, because his patient now has a stable infection that is being controlled by two drugs.

"We want to emphasize that our patient is not rapidly progressing. Nor is that patient's life partner, who is also infected with a similarly highly resistant strain, rapidly progressing," Blick told United Press International at the 3rd International AIDS Society Conference on HIV Pathogenesis and Treatment.

Even though New York health authorities said the strain was unknown, Blick said he knew the source was his patient just a few days later. He said he had received an urgent call shortly after the alarm was sounded from Quest/Nichols laboratory in San Juan Capistrano, Calif. Their HIV database had produced a 99.5 percent match between the New York man and one of Blick's patients, CT01. Blick later received another call from the lab that there was a 98.5 percent match with CT01's partner, CT02.

"When the HIV strain is only about 1 percent different from another, they are usually almost identical," he said. HIV mutates so rapidly that 100 percent identical strains are uncommon if the patients are tested at different times.

Through interviews with his patients and New York authorities, Blick put together the scenario: On Oct. 20, 2004, CT01 provided blood samples that indicated a detectable viral load. The patient told Blick he had missed a few doses of Fuzeon, an injected drug known generically as enfuvirtide. Fuzeon, which prevents entry of HIV into cells, is one of two drugs the 52-year-old man -- who has a long history of HIV infection -- can still take because his viral strain is resistant to all other medications. The only other drug that keeps the virus at bay is efavirenz (Sustiva), a non-nucleoside reverse-transcriptase inhibitor, which prevents the virus from replicating.

"The only two drugs that are effective in the New York man are also Fuzeon and Sustiva," Blick said.

Two days after visiting the doctor, CT01 and CT02 traveled to New York to engage in sex at a club.

"They thought all the people at the club were HIV positive," Blick said. "My patient is devastated that he infected the New York man, whom he thought was already positive."

At the club, CT01 had insertive anal intercourse with ejaculation into the New York man. CT02, a 41-year-old man who has lived with CT01 for 12 years, had insertive anal intercourse without ejaculation with the same man.

Three months later, the New York man showed symptoms of recent infection and was seen at the Aaron Diamond AIDS Research Center. When his CD4 count was measured at 88 cells, the alarm was sounded.

Blick said, however, the New York man's use of crystal methamphetamine and highly promiscuous lifestyle may be more of a factor in his low CD4 count than the strain of virus.

Marc Wainberg, professor of medicine at McGill University in Montreal, said he thinks Blick is correct in identifying his patients as the source of the highly-publicized New York case.

"The evidence is very convincing that he has identified the patient who is the source of this strain of disease," Wainberg told meeting attendees.

He also agreed the New York man probably developed a rapidly progressing form of the disease due to his frequent use of crystal meth, along with his promiscuity. "Who knows what damage that drug does to a person's immune system," he said.

The New York man had sex with at least 10 other partners before he discovered he was infected. Blick said it is possible other infections with that strain may show up later when those men are tested -- if they became infected.

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Edward Susman covers medical research and policy matters for UPI Science News. E-mail: sciencemail@upi.com
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