February 1, 2007
King County, Washington -- Four King County men have tested positive for similar HIV viruses that are highly resistant to several antiretroviral drug classes. One of the men was tested in late 2005, and the other three were tested in 2006. Last month researchers identified a likely link between all four cases. Drug-resistant HIV is of concern because it is more difficult to treat -- drug options are limited and may be less effective, more expensive, and cause more side effects.
"We are still working to learn more about these individuals and the virus they have contracted," said Dorothy Teeter, Interim Director and Health Officer for Public Health -- Seattle & King County. "We are concerned for these individuals and their partners, and are continuing our investigation and heightening our monitoring of HIV drug resistance in our area."
"It's likely these infections are related to one another, but we still don't know how easily the virus is transmitted or how rapidly the condition might progress to AIDS," said Dr. Bob Wood, HIV/AIDS Program Director for Public Health -- Seattle & King County. "Men who have sex with men need to know that drug resistant strains can and are being transmitted, and may be much less treatable. If you aren't practicing safer sex now, use this news as one more reason to reduce your risks."
Public Health is working with the four patients and health care providers to locate and test their sexual partners for HIV infection and drug resistance. Medical providers are being asked to test all clients for drug resistance at the time of a positive HIV test, and report all multiple drug resistant test results to Public Health so that health officials can learn more about HIV drug resistance in the area and support additional education and outreach efforts.
In the current cluster, all four were men who had sex with men; all had a history of methamphetamine use, and had multiple, mostly anonymous, sexual partners. The partners who have been found to date either were not HIV-infected or their HIV infection was not related to the current drug resistant strain.
HIV is treated with many different drugs. Over time, HIV virus can mutate inside people, particularly if people do not stay on their treatment schedule. These changes in the virus may reduce the drugs' effectiveness. Therefore, there are a growing number of people with difficult-to-treat types of HIV. Since HIV is continually mutating, new therapies are being developed to manage the changing virus.
While it may prove difficult to successfully treat patients with this highly resistant form of HIV, patients with this infection may still have treatment options. "Treatment is likely to be cumbersome, expensive, less convenient, and with more side effects than for folks whose virus has no mutations and can take simpler therapies such as once-a-day pills," said Dr. Peter Shalit, a local physician who specializes in care for HIV/AIDS patients.
King County was one of the first places in the country to monitor for drug-resistant HIV. In cooperation with the Centers for Disease Control and Prevention (CDC), Public Health monitors for drug resistance in some local laboratories.
Since 2000, Public Health has identified 12 other multiple drug-resistant cases of HIV. However, most of these cases were not as highly resistant as the current cluster of four cases, suggesting that they could be treated more easily. The fact that the four current cases were infected over a period of at least one year suggests that transmission of this highly resistant form of HIV may be ongoing.
Regular and frequent HIV testing is important for men who have sex with men, injection drug users, and others in the community at higher risk for HIV infection.
"Gay men have heard the message before that unsafe sexual behavior puts them at risk for HIV, and many have listened, protecting their own health and their community," said Dr. Wood. "Along with consistent condom use and telling sexual partners your HIV status, HIV testing is an important key to preventing the spread of HIV and other sexually transmitted diseases."
Public Health recommends testing every three months for those gay and bisexually active men who use methamphetamines, have a recent history of sexually transmitted diseases, or have had unprotected anal sex with an HIV-positive man or a man whose HIV status is unknown. Other persons at high risk should test at least yearly.
HIV remains the most serious of all the sexually transmitted diseases and each year in King County about 100 persons die of AIDS. While most persons who acquire HIV will be effectively treatable, some cases like the ones announced today may be much more difficult to treat. Studies in Seattle and elsewhere have shown that in some at-risk populations, particularly gay men, unsafe sexual behaviors have increased.