New York City on Alert After New HIV Strain Found
A new version of the virus discovered in a New York man is cause for concern in the city’s health care community.
By Mary Raju Cole, RN, MS, FNP, APRN, BC
March 14, 2005
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.
According to a recent edition of Pulse, Crain’s health newsletter, New York State has also stepped up its efforts to make the public aware of the new HIV strain. Besides the current $2.2 million budget, it plans to spend some $450,000 more on marketing and media campaigns, including television announcements that will focus on prevention and the importance of knowing one’s HIV status. State Health Commissioner Antonia Novella, MD, sent letters to physicians who care for patients with HIV/AIDS, asking their cooperation in getting the message across.
Jump the gun?
Some gay activists and HIV specialists, including Robert Gallo, MD, codiscoverer of the AIDS virus, claim that warning the public too soon would be a matter of “jumping the gun.”
Frickey disagrees. “Those at risk must be aware that this is a serious issue and accept the challenge,” she says. “People must take precautions, whether [that means] stopping risky sexual behavior, using condoms, being monogamous, limiting their number of sexual partners, going for HIV testing, or whatever else it takes to remain vigilant against infection.”
New York Mayor Michael Bloomberg agrees. In a recent statement, he noted that he’d rather be early than late in telling the public about a possibly stronger strain of HIV.
Hoping against hope
When the unidentified man was first diagnosed, officials hoped that he might have particular differences in his immune system or perhaps genetic reasons for his drug resistance and subsequent rapid progression from HIV infection to AIDS. Drug use had also been theorized as another possible cause for his fast-moving infection, since amphetamines may suppress the immune system, allowing a virus to replicate more quickly in the body.
While those issues are still being studied, they are unlikely to be the causative factors in his case. Results released later revealed that 3-DCR is especially deadly. Researchers claim that this HIV strain enters cells more easily and grows well in the lab, unlike most drug-resistant strains. It also causes infected cells to clump together, allowing them to destroy uninfected cells.
Lab tests show that the New York man is resistant to three of the four classes of anti-AIDS drugs, so he’s now taking other medications to fight the infection. His doctors have found no sign that his immune system is particularly vulnerable.
What lies ahead
Many call AIDS the plague of the 20th and 21st centuries. And advances in its treatment have created a false sense of security. Once feared as a lethal disease, AIDS is now considered by many to be a chronic condition, with costs and inconveniences, but not as deadly as it once seemed.
On entering the third decade of AIDS, we face a possible new strain of HIV, a powerful adversary that could reach epidemic proportions as a cure remains elusive. Wiping out this disease will take not only a fresh arsenal of medical weapons, but new attitudes, behaviors, habits, and for some a change of lifestyle.
Few people today are unaffected by the tragic toll taken by the first rampage of AIDS in the 1980s. Frickey’s concern is that too many people have forgotten what it takes to keep this potential epidemic in check. Unsafe sex is self-destructive, and AIDS still can kill.
Mary Raju Cole, RN, MS, FNP, APRN, BC, is a Nursing Spectrum contributing writer.
References
1. Santora M, Altman L.. Doctors discover new HIV strain. IHT online website. Available at: http://iht.com/bin/print_ipub.php?file=/articles/2005/02/11/news/HIV.html. Accessed March 3, 2005.