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      #199217 - 07/07/06 03:09 PM

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Case of Multidrug-Resistant HIV and Rapid Progression to AIDS in New York City - Q & A

as of Thursday, March 31, 2005
Background

On February 11th, New York City health officials reported that a local gay man in his mid-40s had recently been infected with multidrug-resistant HIV and progressed rapidly to AIDS. The man was first diagnosed with HIV this past December and is believed to have been infected between four and twenty months before experiencing symptoms of AIDS, including a steep drop in CD4 cells and a high viral load. He also has a history of unprotected anal sex with multiple male partners while using crystal methamphetamine (crystal meth, speed).

Lab tests showed that the dominant viral strain in his body was an aggressive form broadly resistant to the first three antiretroviral drug classes: nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), and protease inhibitors (PIs). However, the man’s virus was susceptible to the fusion inhibitor T-20 (enfuvirtide, Fuzeon) and the NNRTI efavirenz (Sustiva).
According to an update issued March 29 th by the New York City Department of Health and Mental Hygiene, no other cases of multidrug-resistant, rapidly progressive HIV have been identified at this time. Most of the man’s sexual partners known by name have been found, and many were previously infected with HIV. Resistance testing and analysis of blood samples from these men and other people with potentially similar HIV strains are underway and will likely take weeks or months to complete. So far, no other strains are identical to the one found in the New York City man, who remains critically ill but is responding to treatment that includes the two drugs to which his strain is susceptible.

Please note: A great deal is still unknown about this case at this time. We will be revising this fact sheet as new information becomes available. Updated versions of this fact sheet will be available on the San Francisco AIDS Foundation’s website at www.sfaf.org and the California HIV/AIDS Hotline website at www.aidshotline.org.
Questions and Answers
Is this case really new?

Multidrug-resistant strains of HIV are not new. Neither is rapid progression from HIV infection to clinical AIDS diagnosis—in some cases, within months—for some individuals. What is unusual about this case is the combination of broad drug resistance in a previously untreated person and such rapid progression to AIDS (in this case, CD4 counts consistently below 100 cells/mm3, weight loss, and fatigue). This man’s virus also appears to be a virulent, not weakened, form of virus that is associated with rapid disease progression. It would be premature, however, to draw sweeping assumptions or conclusions based on this limited information. Much more needs to be learned in the coming weeks about this case and its implications.
Dr. Julio Montaner of the University of British Columbia in Vancouver published a report in 2003 about two men with a highly drug-resistant strain of HIV that might have progressed rapidly to AIDS. New York City researchers recognize there are similarities between these cases in Vancouver and the newly identified case in New York, but indicate that the recent case is much more dramatic in terms of its progression and resistance profile.
Has such rapid progression from HIV infection to AIDS diagnosis been seen before?

According to experts, the average time between HIV infection and AIDS diagnosis is about eight to ten years or longer. However, this timeframe varies. Some people progress to AIDS more quickly than others due to their own susceptibility, not necessarily because of a “supervirus.” Crystal meth use and others factors specific to the New York individual have been mentioned as potentially affecting his progression to AIDS, but more investigation is needed.
Have similar cases been identified in California?

As noted above, no strains identified at this time are identical to the one found in the New York City case. Additionally, no cases in which a newly infected individual was resistant to multiple classes of drugs and simultaneously progressed swiftly to an AIDS diagnosis have been previously reported in California. On February 14th, the San Diego County Health Department announced that an unidentified San Diego resident might be infected with the same strain of HIV, based on data from a laboratory that compared their database of HIV infections to the genetic sequence of the New York City case. However, San Diego health officials subsequently disclosed that this information was inaccurate and that the blood specimen in question was not from the San Diego area. While it has not been disclosed where the test results originated from, the California State Office of AIDS has been in communication with the laboratory and has confirmed that there is no evidence to indicate that the specimen or patient originated in California.
How concerned should I be about being infected with such a strain of the virus?

Certainly, the potential to become infected with drug-resistant virus is real and has been seen not just in this case but in other cases around the country. Drug-resistant HIV is a problem because treatment options become limited when the virus mutates and doesn’t respond to multiple drugs and entire drug classes. For those who are already HIV positive, there is a small but potential risk of becoming re-infected with a different viral strain. But this one case in New York doesn’t prove that there is a “supervirus” spreading in the community. More questions still need to be answered.
What can I do to protect myself from drug-resistant HIV?

HIV infection, whether drug-resistant or not, can be prevented. For those who are sexually active, standard safer sex practices – in particular regular use of condoms when engaging in higher-risk sexual practices and knowing your HIV status and the HIV status of your partner – are known to be effective tools in reducing the risk of HIV transmission.

For injection drug users it is safest to use a new sterile syringe and equipment (including cotton, filters, caps, spoons, cookers, and alcohol swabs) every time you inject. You can obtain new syringes at needle exchange sites or pharmacies in some locations.
For more information about risk behavior, HIV testing, and needle exchange locations, call the California HIV/AIDS Hotline at 1-800-367-AIDS or visit www.aidshotline.org.
Can I be tested for drug resistance?

Yes. Two different tests, known as genotypic and phenotypic tests, can be used by clinicians to check for drug-resistant HIV. For more information, contact your physician or call Project Inform’s National Hotline at 1-800-822-7422 or visit www.projectinform.org
If I use crystal meth, am I more likely to get HIV or AIDS?

The New York case does not show a direct link between crystal meth use and the progression to AIDS. However, health providers are concerned that crystal meth use is contributing to new HIV infections by lowering sexual inhibitions and impairing judgment. Some experts suggest that crystal meth may negatively impact the body’s immune system. Injecting speed, particularly when sharing needles, carries the additional risk of HIV and hepatitis transmission. For more information about crystal methamphetamine and HIV/AIDS, go to www.sfaf.org/aboutaids/faq_meth.html.
How can I learn more about preventing HIV and getting tested?

Call the California HIV/AIDS Hotline at 1-800-367-AIDS or visit www.aidshotline.org
How to get involved in the HIV Prevention Programs of the San Francisco AIDS Foundation

The San Francisco AIDS Foundation offers a variety of programs and services aimed at reducing the spread of HIV in our community. These programs are described below. You can also get additional information about all of these programs at www.sfaf.org.

Gay Life offers gay and bisexual men the chance to meet in a variety of forums to discuss the challenges they face and to understand the connections between sexual health and emotional and physical well being. HIV is discussed in the context of their whole lives and overall health. For information about upcoming workshops, call 415-788-LIFE or visit www.gaylife.org.

Black Brothers Esteem (BBE) promotes the sexual health and well being of African American same-gender loving men through a weekly drop-in group, workshops and community-building activities. BBE addresses not only the issues of HIV, but also the challenges of poverty, substance use and racism. For information about upcoming activities and other BBE events, call 415-487-8018 or visit www.sfaf.org/bbe/.

The Latino Support Group is the longest running bilingual support group for Latinos living with HIV in the United States. This group is open to all HIV-positive Latino/as and their family members and provides a safe forum to share information on managing HIV and reducing the transmission of HIV. For more information call 415-474-8034.

The HIV Prevention Project (HPP) is one of the largest needle exchange programs in the country. Last year, nearly 2.6 million syringes were exchanged, helping thousands of injection drug users avoid HIV and Hepatitis C infection. HPP also trains secondary exchangers (those who exchange needles for others in their networks) as peer advocates, helping to get clean syringes and information to those who do not visit the exchange sites. For more information about HPP, call 415-241-5100 or visit www.sfaf.org/hpp/.

The California HIV/AIDS Hotline answers 70,000 calls from across the state from people who need information, referrals, and emotional support related to HIV/AIDS. To reach the hotline, call 800-367-AIDS or 415-863-AIDS or visit www.aidshotline.org.

Page last updated 31 March 2005


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Anonymous
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Re: info new
      #199234 - 07/07/06 05:27 PM

You do know that this article is referring to a multi-drug resistant strain. Not some strain that isn't pickup on on the ELISA. The big thing about this isn't really that he got a virus that is resistant. It's that it's resistant to most every drug. Many of us are resistant to some drugs. That's what the geno/pheno typing is used for. To help our doctors determine which combination is best for each of our very unique situations.

I would imagine that on this board, there is very little interest in a discussion on multi-resistant strains and the drug and adherence issues that go along with that.

If you going to post something like this, at least tell people why you think it's relevant.

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Anonymous
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Re: info new
      #199241 - 07/07/06 07:38 PM

to make people aware of the risk it not just hiv and you can live 20 years. to inform on how important it is to stay safe because hiv is changing all the time. to inform people that different strains can cause
different complications. just extra information

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Anonymous
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Re: info new
      #199249 - 07/07/06 08:13 PM

to me it's something that keeps the people that test negative at 3 months going......now they are gonna think that they passed hiv and have full blown aids in a matter of 3 months...good going

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Anonymous
Unregistered

Re: info new
      #199258 - 07/07/06 09:30 PM

I didn't mean it that way this was only one man in new york
but it could be what we could be looking at come years later
If people don't start protecting themself after hiv negative test

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