New Strain of "super" HIV found

[NYCe]

February 13, 2005
http://www.nytimes.com/2005/02/13/nyregion/13aids.html

AIDS Report Brings Alarm, Not Surprise
By RICHARD PÉREZ-PEÑA and MARC SANTORA

As word spread yesterday of a rare and potentially more aggressive form of H.I.V., first reported publicly in New York on Friday, communities already hit hard by the disease, professionals who combat it, and people who are infected reacted with fear and skepticism. But few were surprised, given that the sense of urgency about the disease has waned.


Michael Justiniano, 37, who lives in Park Slope, Brooklyn, said he watched his father die of AIDS in 1993. "I have spoken to young kids, sometimes here, who say, 'If I get it, it's no big deal, I can just take a pill,' " he said. "I'm like, 'Are you stupid?' It is so disgusting, I find it really disturbing."


City health officials announced on Friday that they had detected the rare strain of H.I.V. in one man whose case they described as particularly worrisome because it merged two unusual features: resistance to nearly all anti-retroviral drugs used to treat the infection, and stunningly swift progression from infection to full-fledged AIDS.


That combination, the officials said, could signal a new, more menacing kind of infection, and its discovery set in motion an anxious search by city workers to find the man's sexual partners and have them tested.


The infected man, gay and in his 40's, tested negative for H.I.V. in 2003, then tested positive last December, health officials said. Investigators believe he may have contracted the virus in October when he engaged in unprotected anal sex with multiple partners while using crystal methamphetamine. By last month, it was clear that three of the four classes of anti-retroviral drugs used against H.I.V. were not working in this case, and the man showed signs of AIDS, including rapid weight loss, a high level of the virus in his bloodstream, and a depleted supply of crucial immune system cells.


Even though the anti-retroviral "cocktail" has extended many lives, some infected people still deteriorate and end up with AIDS, but that process usually takes many years. Doctors say that for a patient to reach that stage in a matter of months is extremely troubling.


AIDS experts and public health officials have long maintained that since the development of anti-retroviral drugs in the 1990's, people have developed a false sense that A.I.D.S. no longer poses a significant threat, leading to a rise in unprotected sex. Clear evidence of the trend has been seen in the growing number of cases of sexually transmitted diseases like syphilis, chlamydia, and lymphogranuloma.


In 2003, a survey by New York City's Department of Health and Mental Hygiene found that more than half of city residents with multiple, recent sexual partners had not been tested for H.I.V. in the previous 18 months, and 40 percent said that they had not used condoms the last time they had sex. At the time, Dr. Thomas R. Frieden, the city health commissioner, attributed the results to "H.I.V. precaution burnout."


Mayor Michael R. Bloomberg yesterday described the failure to take precautions against H.I.V. in harsh terms. "It's just a sin in our society, where we know how it's transmitted from one person to another, and we should be able to get people to conduct themselves such that they don't catch it themselves, and certainly that they don't infect anybody else," he said.


Unsafe sex practices combined with growing drug resistance among people with H.I.V., has had officials warning for years about a possible resurgence of A.I.D.S., a fear voiced yesterday by many people across the country as they struggled to make sense of the news out of New York.


Oliver Palan, 19, a gay student at Baruch College, says that he has slept with 10 men recently, none of whom wanted to use a condom. "So many people are like, 'It is so much more fun without the condom,' so they prefer to take the risk," he said, noting that he insists on using condoms. Often, he said, partners will try to dissuade him by saying, "I trust you, you should trust me."


Edsel Gonzalez, 30, a business owner in South Beach, the Miami Beach neighborhood filled with nightclubs and restaurants that is popular among gays, said he was "absolutely worried about this."


"It seems like we're moving backwards in the fight against AIDS," Mr. Gonzalez said. "I'm scared for my son and my family - to think that a type of unknown H.I.V. can resist the affects of modern medicine is unsettling."


Yesterday morning at the Big Cup, a popular coffee shop in the Chelsea neighborhood of Manhattan, the customers, most of them gay men, all talked about how the fear of AIDS had declined, especially among a younger generation that did not have the searing experience of watching friends die. Some said they feared that a new strain of the disease might have emerged, but none were surprised, given the prevailing attitude.


"People got so comfortable with the drugs that they have started becoming complacent," said Will Elosei, 37, from Jersey City. Now, he said, "I think people are going to be more paranoid about everything. Hopefully, open sex will not be a common thing like it is right now."


At an H.I.V. treatment center run by the group Housing Works, in East New York, Brooklyn, an H.I.V.-positive woman named Pat, who would not give her last name, said: "The medications gave people a false sense of security. It gave them a sense that they could do things that before were a death sentence."


People who work in H.I.V. treatment and prevention reported a spike in calls from distraught patients Friday and yesterday, some of them with inaccurate or exaggerated information. "I got a call from someone who had heard that there was a new strain of virus that was spreading around, that resulted in an all but instant onset of AIDS and was totally untreatable," said Martin Delaney, founding director of Project Inform, an AIDS advocacy group in San Francisco.


The true significance of Friday's announcement immediately became a topic of heated debate among scientists who study H.I.V. and AIDS. Many of them said it was too soon to say if the single infection in New York was truly something new. Some noted that they had seen the rapid progression of H.I.V. to AIDS and high drug resistance before, though not both in combination. They said that the New York case could indicate more about the vulnerability of the infected man's immune system than about the dangers of the virus in his body.


"We need better characterization of the virus in this man," said Dr. Marcus Conant, a professor at the School of Medicine at the University of California, San Francisco. "What does it look like genetically?"


Yet he, too, voiced a lack of surprise at the possibility that a more dangerous strain had emerged. "All of us have been expecting for some time there would be the multidrug resistance," he said. "This virus has mutated around what we've thrown at it."


Patrick McGovern, executive director of Harlem United Community AIDS Center, said he was unsure what to think, but added, "I don't know this to be a scare-mongering administration, so I would tend to take them pretty seriously."


Even as he announced the detection of the aggressive strain of H.I.V., Dr. Frieden, the city health commissioner, said that more testing was needed before health officials and scientists could be certain about the extent of the threat. But for now, he said, the responsible reaction was to treat it as a real menace and to alert the public.


Yesterday, doctors and counselors who specialize in H.I.V. treatment and prevention were particularly focused on news that the more virulent infection had appeared in a man who used methamphetamine and then had unprotected sex with multiple partners.


For decades, methamphetamine - a powerful and sometimes addictive stimulant often called crystal meth or speed - was found mostly in states in the West. But it has made deep inroads around the country in recent years, and in much of the nation's midsection it has supplanted cocaine and heroin as the biggest drug problem. In recent years, H.I.V. counselors say, sexual marathons, fueled by methamphetamine and other drugs, have become popular among some gay men.


"In the last 12 to 15 months, we've seen a huge increase in meth use among people that are newly tested H.I.V.-positive," Mr. McGovern said. "People become hypersexual when they're using crystal, but crystal by itself can limit your ability to function sexually. So people combine it with something like Viagra, that lets them keep going for hours."


Doctors disagree about the role methamphetamine may play in making users more susceptible to infection, but there is widespread agreement that it lowers inhibitions and can lead to more unprotected sex and more frequent sex with multiple partners.


Dennis DeLeon, the president of the Latino Commission on AIDS, said it was common for men using methamphetamine to have sex with 10 to 20 partners in one night. "It is a drug where they just lose count," he said.


Most gay men do not engage in such behavior, nor is it limited to gays. But medical history has shown repeatedly that a small number of infected people can sow an epidemic.


With doctors, medical researchers and public health officials now on the lookout for signs of a spreading condition, the true nature of the threat may soon become apparent. Health officials seeking to protect the infected man's privacy have said little about him except that he had been very active sexually - one person briefed on the case said he had had hundreds of sexual partners - raising the prospect that others have been infected with the same strain. If the virus is as dangerous as some health officials fear, similar cases could be expected to crop up soon.


If experts were uncertain how concerned they should be, average citizens were even more so.


At the Housing Works center in Brooklyn, where most of the clients are black, some said they thought a more virulent form of AIDS was old news, others said they believed it affected only white people, and still others said the entire affair was an overreaction.


Lissa Welchel, 32, a wine broker in Miami, said the more she learned about of the strain the more worried she became. "What scares me the most is the rapid progression of this strand," she said. "AIDS is a scary disease in itself and to think that an unknown strand with such power could be transmissible is a definite alarm for concern." Still, she said she was unsure how big a deal it was. "I hope that this is just a single case and we don't experience a wide-spread event of people dying from AIDS years before their time," she said.

[geekmeat]

These men that are doing this are irresponsible and just plain evil.
These are gay men knowingly having unprotected sex.
They are pigs.
Before when AIDS first hit no one knew about it so there was an excuse.
There are no more excuses.
Unfortunately I knew something like this was coming.
I really dont think there will be a cure because they say the AIDS virus mutates like the common cold and we all know the common cold hasnt been erradicated.
The behavior of these individuals is sick,its wrong and its evil.
They say the guy who they discovered that had this has had HUNDREDS of sex partners......all since 2003 when he last tested positive.
By this own individuals admission he was engaging in "bareback" anal sex.
This kind of behavior should be criminalized.
Im sorry thats just how I feel........

[AllanahStarrNYC]

Another intelligent and well thought out post from geekmeet-

Sorry Geek, we don't all live in your world were Vaniity is a super hero and facist sex laws are enforced

If u have unsafe sex u are at risk for a multitude of std's
and u have to abide by the risk and know the consenquences-

"these men"
are everyone-
gay men are NOT the only group of people having unsafe sex

this person seems like he was a heavy crystal meth user and i am sure this has alot to do with his health condition as it is well known people who are drug addicts or heavy drug users have impaired immune systems as well.

[Felicia Katt]

hear hear Allanah. If there ought to be a law, it should be against using crystal meth. Oh wait, that's right, there are already laws against that. Instead of passing more laws, people need to take more self responsibility for their actions. So long as you yourself always use a condom, and choose your partners and activities with some discretion, you shouldn't have to worry about HIV or other STD's. If you aren't willing to do that out of self concern, you aren't very likely to do it because the law mandates it. Seatbelts are mandatory and lots of idiots drive and die without them.

Felicia

[Mugai_hentaisha]

Another intelligent and well thought out post from geekmeet-

Sorry Geek, we don't all live in your world were Vaniity is a super hero and facist sex laws are enforced

If u have unsafe sex u are at risk for a multitude of std's
and u have to abide by the risk and know the consenquences-

"these men"
are everyone-
gay men are NOT the only group of people having unsafe sex

this person seems like he was a heavy crystal meth user and i am sure this has alot to do with his health condition as it is well known people who are drug addicts or heavy drug users have impaired immune systems as well.

i agree with allanah on this, really geekmeat. there has always been reasons if you will, for condom use even before HIV. Allanah is also right condom use. Condom use is down among every group to me, otherwise why would TROJAN be forced to run their corny ass adds on television?

Hate to inject my sense of humor at a very solemn topic but it helps me deal with this.

Vanity hell Allanah, Hell when you were potographed with that Patriotic costume. you became mine :P

[Skwisgarr Skwigelf]

I read a story in a newspaper a while back about a man who had been diagnosed with AIDS and as a result had intentionally slept with as many women as he possibly could I believe he managed 10 before he got arrested and if I'm not mistaken he went to jail for 10 years

[Luna555]

some men just want to see the world burn....(yes I got that from tdk)

[BrendaQG]

some men just want to see the world burn....(yes I got that from tdk)

I believe that it is already illegal to knowingly spread HIV.

I have seen news stories where people have been successfully prosecuted for attempted Murder, man slaughter etc for this. I mean suppose this guy gave every one of his "hundreds" HIV. He would bear some kind at responsibility for those infections.

On the other hard if this is a new strain at aids it has been cooking for a while. He would not be the first to have it Just the first we know about. Who infected him? Where are they? what happened to them? Those are the really interesting questions!

[lupinIII]

There've seen a few cases here in Australia as well, where guys have been prosecuted for intentionally infecting women with HIV.

In terms of the rising infection rates, I guess people are still just too unaware of the facts regarding HIV, thinking its only the marginalised sectors of society who are at risk when in truth it doesn't discriminate, it's an equal opportunity killer.

We need to resurrect and update ads like these...



When this ad came out in the 80s in Australia it scared the living fuck out of people.

On a lighter note there's also this.

[SarahG]

I read a story in a newspaper a while back about a man who had been diagnosed with AIDS and as a result had intentionally slept with as many women as he possibly could I believe he managed 10 before he got arrested and if I'm not mistaken he went to jail for 10 years

And who knows how many people will be infected now that he's in corrections were people don't care about contagious diseases.

On the lighter side I saw this last night:

"Elite" HIV wife may hold secret to AIDS vaccine

By Maggie Fox, Health and Science Editor Tue Aug 12, 4:56 PM ET

WASHINGTON (Reuters) - A woman who has never shown symptoms of infection with the AIDS virus may hold the secret to defeating the virus, U.S. researchers said on Tuesday.

Infected at least 10 years ago by her husband, the woman is able somehow to naturally control the deadly and incurable virus -- even though her husband must take cocktails of strong HIV drugs to control his.

She is a so-called "elite suppressor," and studies of her immune cells have begun to offer clues to how her body does it, the team at Johns Hopkins University in Baltimore said.

"This is the best evidence to date that elite suppressors can have fully pathogenic virus," said Dr. Joel Blankson, who led the study.

"The feeling was initially that they had defective virus," Blankson added in a telephone interview.

But the couple has been monogamous for at least 17 years, Blankson said, and tests show they are infected with the same strain of virus. What is different is the immune system of the wife, who cannot be named for privacy reasons.

"That's a good sign in terms of developing a therapeutic vaccine," Blankson said. Such a vaccine would not prevent infection but might be used to treat patients.

The AIDS virus infects at least 33 million people globally and more than a million in the United States. It has killed 25 million people since it was identified in the early 1980s.

New figures show 56,000 people are infected every year in the United states, mostly gay and bisexual men but also injecting drug users and their sexual partners, both male and female, as well as newborns and recipients of contaminated blood transfusions.

STALLING REPLICATION

Both the man and the woman, who are from Baltimore, were diagnosed 10 years ago, Blankson said. The husband is a former injecting drug user.

Tests showed that immune cells known as CD8 T-cells from the wife stalled HIV replication by as much as 90 percent, while the husband's T-cells stopped it by only 30 percent, Blankson's team reported in the Journal of Virology.

Her virus has also mutated in apparent response to this immune attack, becoming weaker, while her husband's virus has remained strong.

"Elite suppression offers clues to vaccine researchers on many fronts: how CD8 killer T-cells can attack HIV and how a stronger immune response can force HIV into a permanent defensive state," Blankson said.

"We are trying to figure out exactly how the T-cells work in her to inhibit viral replication," he added. "We are just trying to see what kind of cytokines they make."

Cytokines are immune system signaling proteins. One thing the researchers have noticed is that while the husband's T-cells make just one, called gamma interferon, hers made both that one and another called TNF, or tumor necrosis factor.

That cannot be the whole story, though, because AIDS researchers have tried using such immune system proteins in patients and they did not work well.

And her immune cells seem to make the response only when they encounter the virus.

Another clue: the woman may have unusual activity in her human leukocyte antigen system, or HLA, Blankson said. This important component of the immune system helps recognize antigens -- protein identifiers -- of enemies such as bacteria and viruses.

(Editing by Will Dunham and Philip Barbara)