New epidemic or flawed research?
HEALTH AND WELLNESS / Debate rages over emergence of HIV ‘super strain’ in New York

story by Julie Weisberg / Xtra! and Xtra West! Mar 17 2005

AIDS activists, scientists, health professionals and media pundits have been dwelling on the same question for weeks now. Has a gay, middle-aged New York City man contracted a new HIV super strain or not?

The debate has raged ever since the New York City Department Of Health And Mental Hygiene (DOH), with strong support from the US federal government's Centers For Disease Control, announced the discovery of a rare and "highly virulent strain of HIV" during a Feb 11 press conference.

Health commissioner Thomas Frieden says the strain not only is resistant to three of the four licensed classes of anti-retroviral drugs used to suppress the virus, but also appears to have rapidly progressed from initial HIV infection to full-fledged AIDS, perhaps in as little as eight weeks. The average AIDS onset after HIV infection is about 10 years.

The DOH says the gay man in question had been sexually active after his estimated time of infection of October 2004, frequently engaging in unsafe sexual encounters while under the influence of crystal meth, until he began to feel ill November and was diagnosed with HIV in December.

"It's a wake up call to men who have sex with men, particularly those who may use crystal methamphetamine," stated Frieden in a Feb 11 press release.

"This community successfully reduced its risk of HIV in the 1980s, and it must do so again to stop the devastation of HIV/AIDS and the spread of drug-resistant strains."

But skeptics wonder whether the New York case warranted such a dramatic public health announcement. Frieden and lead researcher David Ho have been accused of trying to advance their own personal agendas: Ho to shine the spotlight upon himself before the annual AIDS conference held in Boston late last month, and Frieden to stress safer sexual practices among the city's gay men. Both have denied the accusations.

One of the skeptics is Robert Gallo, who co-discovered that the HIV virus causes AIDS in 1987 and who is currently at the University Of Maryland Biotechnology Institute. Gallo wonders about the quality of information, which was still in the preliminary testing stage at the time of the press conference.

"If you don't have enough knowledge, you should seek advice. I know it sounds strange probably, but health people can't be an expert on every virus," he says. "They had reasons, I'm sure, to be concerned... about this new drug addiction [crystal meth]. They have reason to be concerned about drug resistance. But it is not a new story."

Not only does Gallo suggest that it is "highly, highly unlikely" that this strain is an HIV super virus, he also has doubts that the NYC man even has AIDS.

Gallo says that if the man was in the first two months of infection when he was tested, he could have been in peak viremia "the height of the virus presence in the blood of a host" due to his own individual variation, which would have nothing to do with the virus itself. But it can lead to misdiagnosis.

In addition, Gallo says drug-resistant viruses "are all over the place."

"Fifteen percent of the new patients that come into the clinic are multi-drug resistant. And so do they ever have a potent strain? It can happen. It is in the literature "I mean, you've got Julio Montaner."

Julio Montaner, a professor of medicine and chair of AIDS research at the University Of British Columbia, dealt with two similar cases in Vancouver four years ago and published his findings. Like the recent case in New York, Montaner says both his patients suffered from a multi-drug resistant virus that appeared to rapidly progress into AIDS.

Pointing to Montaner's previously published report, some people have criticized Ho for touting the newness factor of the New York case. Montaner, who has recently spoken with Ho, says people should not be so quick to judge Ho's warning.

"Let's just be clear that HIV is the number one villain here," says Montaner.

Though Ho's intentions were good, Montaner worries that the warning might have negative public health implications if, for example, the New York virus turns out to be less virulent than first thought.

"If there is no resistant virus, people may think, 'Oh, I don't have to be careful, there's no super virus," he says. "By default, what we would be saying is, 'HIV is fine, but multi-drug resistant is not fine.' Well, any kind of HIV is bad news, and a huge burden to live with. You don't want to go there."

Montaner says it is important for gay men to step up their safer sex practices, or cases like the one in New York and Vancouver could become more widespread.

"Multi-drug resistance is extremely infrequent at the moment, but the more people practice foolish sex the more frequent this is going to happen," says Montaner.

Lynn Schulman of the Gay Men's Health Crisis (GMHC) says the New York case has come at a time when HIV infections among gay men are on the rise and prevention efforts in the US continue to be seriously underfunded and increasingly censored.

"It [the NYC case] just brings to the forefront attention again to prevention issues" that it's very important to practice safer sex," says Schulman. "There's been this sort of fatigue around prevention over the years. What's more of a concern is that people aren't practising safer sex. We need to learn to love in a way that's safe."

Schulman also knows of another "extremely similar" case of a drug-resistant, rapid progression virus recently identified in San Diego. The infected individual, however, has yet to be identified as the test was administered anonymously.

"What happened is that they found out from lab reports that were reported to the state that is was a very similar case. And they are trying to track that back," says Schulman. "One case, and you're kind not sure whether it's that particular individual or it's something beyond that, but when you have two cases that's different."

Still, Gallo remains skeptical about the inevitability of an HIV super strain, which he says would require " traumatic genetic change" that would allow the virus to target and enter through the nose and the mouth "like the common cold" or where ever a virus would enter "that is casual."

"In my judgment, almost every variant that you could imagine has been recreated, by recombining these genes, and it is very unlikely to create a super virus," says Gallo. "Super virus means that it is causally transmissible, easy to transmit "and that's just not going to happen."

In fact, Gallo says it is far more likely that over many generations, humans will actually adapt to the virus, reducing its ability to wreak havoc upon our immune systems.

But, in the mean time, Gallo says the people should focus on prevention efforts and finding a cure.

"We've got enough to worry about with HIV," he says. "It already is a super bug."