The virulent and highly drug-resistant case of AIDS recently found in a New York City man is similar in some ways to two Canadian cases that appeared in 2001 and did not lead to the spread of a "supervirus," as some fear may happen in New York.
The Canadian cases turned out to be readily treatable despite their worrisome features. The infected patients -- two men who had no contact with each other -- are alive and in good health, said the physician who treated them. He originally described the unusual findings two years ago in a medical journal.
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"They have done well. Everything is fine. But they did get into the race with a bit of a handicap," said Julio Montaner, chairman of AIDS research at the University of British Columbia. He acknowledged, however, that the New York case was "more florid, with more resistance and the patient more sick" than his patients were, and their experience may not predict the fate of the New York man or the people he may have infected.
New York City's health commissioner, Thomas R. Frieden, announced a week ago that a man in his forties had advanced AIDS diagnosed in January, 20 months after he had tested negative for HIV. Tests on the virus in his blood showed it was resistant to three of the four families of anti-retroviral medicines.
The man, who is gay, reportedly had more than 100 sexual contacts over the past six months, including many anonymous partners he met through the Internet. He engaged in unprotected intercourse while under the influence of methamphetamine, also known as "crystal." At the time he tested HIV-positive, his CD4 cell count -- a gauge of the health of his immune system -- was lower than 100, a sign of advanced AIDS. A normal CD4 cell count is more than 650, and U.S. patients generally are infected 10 years before the CD4 count drops that low.
The appearance of galloping AIDS and triply resistant virus in the same patient raised the possibility that a previously unseen, supervirulent strain of HIV had emerged. Worrisome under any circumstances, the appearance of such a pathogen in the subculture of drug-using gay men, in which anonymous sexual encounters are common and safe sex practices are rare, is especially frightening.
Public health officials are urgently trying to find the man's partners. As of last week, at least two had come forward. One has been infected for years, is on treatment and could not have gotten the virus from the man with the recent diagnosis. The other person refused to be tested for HIV and did not want to discuss matters further, said a person familiar with the case.
A strain of HIV with a very similar, although not identical, genetic profile as the one in New York was recently found in the archive of a national AIDS testing lab in California. The strain was originally reported to have come from a patient in San Diego.
Yesterday, however, San Diego County's public health officer, Nancy Bowen, said further research showed the patient was not from her area and she did not know where the patient was. New York City health officials have asked the commercial lab to help trace the source of that sample.
The British Columbia cases also involved a drug-resistant virus and disease that progressed rapidly -- although neither was as extreme as the New York case.