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Drug-Resistant AIDS Case Remains a Puzzle

By David Brown
Washington Post Staff Writer
Friday, February 25, 2005; Page A10

BOSTON -- The mystery of the rapidly progressing case of drug-resistant AIDS in New York City remained unsolved yesterday despite the attention of several thousand AIDS researchers from around the world.

The physicians investigating the case offered a few new details to researchers attending the 12th Conference on Retroviruses and Opportunistic Infections, the annual midwinter AIDS meeting in the United States.

Experts in drug-resistance and rapid-progression in AIDS provided data from other studies showing that whatever else it may be, the unnamed gay New Yorker's experience is very rare. However, it is clear that only further study, particularly of the man's sexual partners, will reveal whether he is carrying a "super strain" of human immunodeficiency virus (HIV), as some people fear.

Two weeks ago, New York City's health commissioner, Thomas R. Frieden, announced that a gay man in his forties had been found infected with HIV resistant to three of the four families of antiretroviral drugs. He was suffering from advanced AIDS, but had become infected at most 20 months -- and possibly only three months -- earlier. In either case, his decline was unusually rapid, as most people carry the virus for eight to 10 years before progressing to his advanced stage.

"The investigation is ongoing and will most likely continue for many weeks," said Lucia Torian, New York's director of HIV surveillance and epidemiology.

The man has given health department investigators names of his sex partners -- the number is "in the teens," Torian said -- and about two-thirds have been contacted. The investigators are asking them to get HIV tests or, if they know they are infected, to have the virus in their blood tested for drug resistance. She would not provide any results to date.

In addition, she said, Frieden will soon send letters to six large commercial labs, and several smaller ones, that do most of the country's HIV testing and request that they report to his department all samples of multi-drug resistant virus drawn from New York City residents. Health regulations give Frieden this power during disease outbreaks. The order will run through May 31, and can be extended, Torian said.

At the meeting yesterday, David D. Ho, head of the Aaron Diamond AIDS Research Center, said the patient believed he was infected in the third week of October after having unprotected anal sex with several men. In early November, he was fatigued, had a sore throat and malaise, which are often seen immediately after HIV infection. In late December, his CD4-cell count was 80 (down from the normal count of about 650), and by early this month he had lost 10 pounds -- both signs of advanced AIDS.

In a symposium hurriedly added to the conference schedule, a Johns Hopkins researcher named Stephen Gange said that records from a large group of gay men observed since the late 1980s showed that in seven out of 10,000 cases, a person developed AIDS within six months of infection -- as would be happening here if the man became infected last fall.

What is not known is whether the explanation for the rapid decline lies in the patient or the virus -- or some combination of both. Ho told the group the patient has none of the obvious immunological defects or quirks that can make HIV infection progress rapidly, but that subtle "host" abnormalities have not been ruled out.

If it turns out the man infected other people -- or that others were infected with the same strain when he was -- and their health is rapidly worsening, that will be strong evidence the virus is unusually virulent and dangerous, doctors say.

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