Lancet Publishes Genetic Study of Rare, Drug-Resistant HIV Strain Found in NYC Patient
The March 19 issue of the journal Lancet includes a genetic study of the rare, drug-resistant HIV strain found in a New York City patient, AFP/Yahoo! News reports. The study -- based on the work of a team of researchers from the Aaron Diamond AIDS Research Center, where the patient was diagnosed in December 2004, and led by the center's Director Dr. David Ho and Dr. Martin Markowitz -- describes the virus as a unique variant that is resistant to multiple classes of antiretroviral drugs and associated with rapid disease progression, according to AFP/Yahoo! News. The study identified the 3-DCR virus found in the patient as a mutated strain of the B subtype of HIV-1, which is considered to be the "most widespread" of the two main types of HIV, AFP/Yahoo! News reports (AFP/Yahoo! News, 3/17). Officials from the New York City Department of Health and Mental Hygiene on Feb. 11 announced that they had detected the HIV strain. The city health department issued an alert to physicians, hospitals and medical providers asking them to test all HIV-positive patients for evidence of the strain. The combination of highly drug-resistant HIV and rapid progression to AIDS had not been identified before (Kaiser Daily HIV/AIDS Report, 3/1). The genetic study also shows the virus "to be particularly effective" at entering human immune cells by latching on to two separate receptors, CCR5 and CXCR4, the New York Times reports. HIV usually only attaches to one of the receptors to enter cells. The study will allow HIV/AIDS experts and medical professionals worldwide "to more accurately evaluate the scientific basis of the alert," according to the Times.
Comments, Current Investigation
The alert issued by the New York City health department has created "debate about the importance of the discovery" because some scientists think one case does not "warrant much concern," according to the Times. In addition, some gay advocacy groups "reacted skeptically," saying that public health officials were using the case to "scare gay men into practicing safe sex," according to the Times. The city health department "has repeatedly defended its decision" but remains "silent" about the ongoing investigation, the Times reports (Santora, New York Times, 3/18). "Only additional investigations will reveal whether this case is isolated or not," the researchers state, adding, "Irrespective of the outcome, efforts to prevent HIV-1 transmission need to be intensified, with particular emphasis on the epidemic that is being propelled by the use of methamphetamine. However, in doing so, care should be taken to avoid punitive measures against the populations most vulnerable to HIV-1" (Markowitz et al., Lancet, 3/18). For about a month, investigators have been tracking down the sexual partners of the New York City patient, a process that has been "difficult" because the man did not know the names of many of his partners, according to the Times. Health workers have taken blood samples from more than 12 potential sexual partners of the man and currently are testing the samples to determine if the virus has been transmitted to others, according to an unnamed official involved in the case, the Times reports (New York Times, 3/18).
"This case serves as a reminder that HIV remains a frighteningly versatile foe, one that can mutate to escape immune attack or to acquire drug resistance with surprising speed," an accompanying Lancet editorial says. The "lesson" to be taken from this case is that despite all of the scientific advances made with HIV/AIDS, "prevention remains the most effective strategy to combat HIV, especially prevention efforts that target high-risk groups," the editorial says. However, religious conservatives have adopted a "'just say no' approach" that "has failed to prove effective," according to the editorial. Despite this, "U.S. officials have promoted abstinence-only sex education over more effective comprehensive programs, ... harassed researchers and outreach groups, ... pressured U.N. agencies to drop needle-exchange programs" and "insisted" that groups receiving U.S. funding "ascribe to policies opposing prostitution," the editorial says. The Bush administration "seems to be more interested in imposing its moral view of the world than saving lives, sacrificing others for its ideology instead of doing what's right," the editorial concludes (Lancet, 3/19).