A fast and furious virus
Two distinct rarities in the AIDS epidemic have had researchers worried. For some patients, antiviral drugs no longer work. For other patients, the human immunodeficiency virus progresses to AIDS in a few months, much faster than the typical decade or so.
When an anonymous patient in New York City exhibited both of those troubling traits, a public-health alert was sounded. "A highly resistant strain of rapidly progressive human immunodeficiency virus has been diagnosed for the first time in a New York City resident who had not previously undergone antiviral drug treatment," the New York City Department of Health and Mental Hygiene said on February 11.
Raising questions. The information posed more questions than answers. It will take time to sort out whether there is a link between multidrug resistance and rapid progression or if the patient himself, a gay man in his mid-40s who used the drug crystal methamphetamine and had multiple sex partners, was uniquely vulnerable to a quick onset of disease. It's possible that his lifestyle or genetic makeup made him inherently more susceptible to a rapid progression. Public-health officials are contacting as many of the man's partners as they can to find out if any have been infected. Then they need to see if the partners have had an equally quick course.
"More often than not, [rapid progression] has something to do with the person infected, not the virus itself," says Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
Patients can become resistant to AIDS drugs if they start but fail to continue a course of treatment. The virus mutates, and the drugs become ineffective when used again. In other cases, patients strictly adhere to drug treatment but over time become resistant to one or more drugs, and the treatment regimen must change. If such a patient infects another person, the newly infected person picks up the drug-resistant strain. Even someone already diagnosed with HIV/AIDS could, through unprotected sex, shared needles, or contact with contaminated blood, become reinfected with a drug-resistant strain of the virus.
"It's a reminder of the seriousness of AIDS and the enormous continued work we must do around prevention," says Ana Oliveira, executive director of Gay Men's Health Crisis in New York City. There has been no increase in funding for HIV prevention education in President Bush's 2005 budget request, at $941 million. "The funding of prevention has not been based on effective science," says Oliveira. "It has been based on moral beliefs."
Science is only beginning to understand how the AIDS virus mutates and what that means for treating an individual patient--and a population. With only two or three good alternatives available in drug treatment, when is the best time to switch a patient and try something new? "We're just at the beginning of knowing how to make good clinical decisions about drug resistance," says Rick Marlink, senior research and executive director of the Harvard AIDS Institute.
It's too early to tell just how bad an omen this New York patient represents. It is a worrisome twist, but "the epidemic is already here. Practicing safe sex will prevent any version of the virus. The virus already among us is infectious. It kills," says Marlink. "It can be prevented."
This story appears in the February 28, 2005 print edition of U.S. News & World Report.
advertisement
