Important note: Information in this article was accurate in 2005. The state of the art may have changed since the publication date.
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Wall Street Journal - February 16, 2005
Marilyn Chase at marilyn.chase@wsj.com
Dr. Ho, head of the Aaron Diamond AIDS Research Center in New York, alerted New York public-health officials about a patient who was infected with a highly drug-resistant version of HIV, the virus that causes AIDS, and who developed full-blown AIDS far more quickly than usual. Officials publicized the finding, setting off a controversy over whether the resulting public worry was warranted. Public-health officials say they want to curb the risky behavior that characterized the patient, a gay New Yorker in his late 40s who had fueled anonymous sexual encounters with the drug crystal methamphetamine.
Dr. Ho promised to publish full details of his findings soon in a scientific journal. The virus was resistant to three of the four main types of AIDS medicines, making it difficult to treat.
Critics have said that given there is so far only a single case, "It's inappropriate to induce any type of hysteria," said Warner C. Greene, director of the Gladstone Institute of Virology and Immunology in San Francisco. "We should assemble all the data before making announcements about a new and more lethal strain of HIV."
Some observers also questioned whether the patient's rapid decline into AIDS was due to some special strength of the virus, or due to independent problems with the patient's immune system or his drug use. Drug-resistant versions of HIV often end up declining in virulence, slowing the progression of patients to full-blown AIDS. Researchers at University of California at San Diego reported in December 2003 that methamphetamine hastens HIV replication, which could be a factor in the patient's illness.
"It's premature to declare this a 'super virus,' " said Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases.
Dr. Ho vehemently denied the strain was crippled like many other strains of mutant HIV. "There's no indication this virus is wimpy in the laboratory," he said, though he conceded, "We cannot say it's particularly aggressive." Further study is needed, he said.
He also insisted the patient's declining immunity represented a real case of accelerated AIDS, not a temporary decline in immune function that often happens to HIV-infected patients before they clinically develop AIDS. Some critics have said it is premature to say the patient came down with AIDS in a short period of time.
Resistance -- common in chronic AIDS cases being treated with drugs -- is also found in 3% to 15% of recently infected people too, said Julio Montaner, a professor of medicine at the University of British Columbia in Vancouver. Moreover, multiple-drug resistance in newly infected people with rapid collapse of immunity isn't new, he said. He found such a phenomenon in 2001, and in 2003 published his findings in the journal AIDS.
"You can make a tempest of anything you want," Dr. Montaner said. "Our approach was to say this is a problem, HIV is in the community, so ladies and gentlemen, be careful."
Dr. Ho said he alerted New York City health officials because he feared such cases were going undetected.
Catching one early case prevents the spread of HIV to two more people on average, said Jeffrey Klausner, director of STD prevention and control at the San Francisco Department of Public Health. "It's critically important to identify infected individuals," and offer counseling to prevent transmission, he said.
Tests for antibodies to the AIDS virus can get results in 20 minutes. However, people infected with HIV can be infectious for months before they develop antibodies. San Francisco public clinics routinely double-check patients with negative antibody tests.
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