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On February 12, newspaper headlines once again stunned New Yorkers and struck fear in the heart of a city that has seen more than its share of bad news since the turn of this century. A new, drug-resistant, possibly lethal strain of HIV named 3-DCR had been found in an unidentified man whose amphetamine use may have prompted unprotected anal sex with many partners.

As Thomas Frieden, MD, commissioner of New York’s Department of Health and Mental Hygiene, announced this news, physicians, community leaders, and the general public were reminded of the same shock and dread they felt more than two decades ago when AIDS first took its toll on an unprepared society.¹

Why panic?

First recognized in 1981, AIDS has become well-known around the world. HIV has been successfully managed by a combination of antiviral drugs since 1996, and the number of AIDS-related deaths has fallen dramatically since then.² So why is this infection causing such alarm?

Jessica Frickey, health communications specialist at the Centers for Disease Control and Prevention in Atlanta, explains it. “People have been effectively treated for so many years now that they have started to minimize the seriousness of HIV/AIDS,” she says. “They’ve grown complacent about the disease. This has been the worst kind of wake-up call to remind them that AIDS is still around and stronger than ever.”

Cumulative effect

“Several major factors make this recent attack of HIV unusual,” Frickey adds. “While some [persons with AIDS] with new infections have previously demonstrated resistance to several different drugs and a small number have quickly progressed to the disease, the combination of these two traits is most alarming.”

Health officials say that the New York patient tested negative for HIV in May 2003. Investigators believe he became infected in October 2004 when he engaged in unprotected anal sex with multiple partners while under the influence of crystal meth. This past December, he tested positive for HIV and was treated with antiviral agents. Within four months,
he was diagnosed with AIDS.¹

This rapid deterioration points to a new viral strain. “The fact that this man’s clinical course may have gone from infection to full-blown AIDS in as little as four months 85 warns us to remain vigilant about the HIV virus,” says Frickey. “On average, a person develops AIDS 10 years after being infected with HIV. It’s premature to say exactly what [3-DCR’s] scope and severity will be, but limiting its impact is crucial.”

Containing the damage

Another frightening aspect of this case has been the involvement of the “club drug” crystal meth. The drug has been called a “petri dish for AIDS transmission” by gay advocacy groups because of its disinhibiting properties, which tend to promote multiple partnering.

Frickey believes that this makes tracking contacts and curtailing the spread of the virus a nightmare. In the case of the New York man, this is especially problematic, since he met some of his partners on
the Internet.

Researchers also hypothesize that the man contracted the HIV strain by having sex with someone who already had AIDS and who had developed a resistance to anti-AIDS drugs. Unfortu­ nately, this means that the origin of infection remains unrecognized in the community.¹

Where do we go from here?

“Right now, we must do everything that has worked in the past,” says Frickey. “We should continue education programs that were successful in persuading older generations of gay people to avoid risky sexual behavior, continually reinforcing the danger of unprotected sex.”

Screening for sexually transmitted diseases, treating substance abuse, and dispelling myths about HIV are all part of working against this adversary, she says. “And there is a misperception that HIV is easily treated.”

Patients taking the anti-AIDS drug cocktails must realize that they are still contagious. And although antiretroviral drugs prolong the lives of people with AIDS, more drug-resistant strains of virus will continue to turn up with the use of these cocktails.

The New York health department is encouraging drug- resistance testing for all those newly infected with HIV, promoting HIV testing in a confidential manner, and recommending the simplification of drug regimens for treatment support. It is also trying to improve its tracking systems for HIV drug-resistance patterns.