Investigators have identified several patients who might have a related strain of the rare, highly drug-resistant HIV strain detected in a New York City man last month but are unsure if the cases are related, New York City health officials said on Tuesday, the New York Times reports (Santora, New York Times, 3/30). Officials from the New York City Department of Health and Mental Hygiene on Feb. 11 announced they had detected the HIV strain, which is resistant to most antiretroviral drugs and possibly causes a rapid onset of AIDS. The city health department issued an alert to physicians, hospitals and medical providers asking them to test all HIV-positive patients for evidence of the strain. This combination of highly drug-resistant HIV and rapid progression to AIDS had not been identified before (Kaiser Daily HIV/AIDS Report, 3/29). City health department officials would not say exactly how many patients had been identified as possibly having the rare strain and said it could take several months to determine if there is a connection (AP/1010 WINS, 3/30). "The extent to which this strain has spread remains under investigation," the city health department said in a statement (AP/Yahoo! News, 3/30).
Current Investigation, Comments
New York City Health Commissioner Dr. Thomas Frieden cited the ongoing investigation and patient confidentiality concerns as reasons for not detailing how many people were contacted and how the cases were found. Some of the people may have been contacted because they were identified as sexual partners of the New York City man, and others may have been detected through the city health department's survey of laboratories that conduct HIV testing and research, according to the Times (New York Times, 3/30). For more than a month, investigators have been tracking down the sexual partners of the New York City patient, a process that has been difficult because the man did not know the names of many of his partners. According to an unnamed official involved in the case, health workers as of earlier this month had taken blood samples from more than 12 potential sexual partners of the man and currently were testing the samples (Kaiser Daily HIV/AIDS Report, 3/18). "As of today, no other cases of multidrug-class resistant, rapidly progressive HIV have been identified," health officials said. Frieden said that the health department "made the right decision" in issuing a public health alert, despite criticism of its handling of the case, according to the Times. "It is certainly the case that because we did go public we are more likely to find future cases as they occur," Frieden said. He added that the investigation has revealed "disturbing behavior patterns," according to the Times. "The social network surrounding this case indicates that unsafe, anonymous sex, along with the use of illicit drugs, including crystal methamphetamine, remains common," the department said in its statement.
Patient Responding to Treatment
Health officials on Tuesday also announced that they are "encouraged" that the New York City patient appears to be responding to antiretroviral treatments, including two licensed drugs, the Times reports (New York Times, 3/30). The rare strain is resistant to three of the four approved antiretroviral drug classes, and the patient has shown resistance to 19 drugs (Morris, Long Island Newsday, 3/29). However, the update "indicates that the strain, while difficult to treat, appears to be treatable at this point," the health department statement said. However, the patient remains "critically ill," according to the statement (NYC health department statement, 3/29). "It is probably the most encouraging thing there is about this investigation," Frieden said (New York Times, 3/30).
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Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, or sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv. The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of the Kaiser Family Foundation, by The Advisory Board Company. © 2004 by The Advisory Board Company and Kaiser Family Foundation. All rights reserved.