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New Yorker's Rapid HIV Seen as Danger Sign

Fast-Moving, Drug-Resistant AIDS Virus Points to Prevention Failure
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March 17, 2005 - The drug-resistant AIDS virus that emerged in New York is a warning that HIV prevention efforts are failing, public health experts warn.

Last month, the New York City health department announced alarming news. A man developed AIDS only months after getting infected with an HIV strain resistant to most anti-HIV drugs. Usually the virus takes many years to cause disease.

The announcement led to speculation that a "supervirus" may have evolved. But it's not the first time a highly resistant AIDS virus has been linked to rapidly worsening HIV disease. And it's not yet clear whether the New Yorker's extremely fast progression from infection to AIDS is due to the virus, to the man's genetic makeup and underlying health, or to both.

Public health experts are tracing the man's many sex partners. So far, there's been no report that anyone else is infected with the same drug-resistant HIV. But the case still is a concern, says infectious disease expert Carlos del Rio, MD, chief of medicine at Atlanta's Grady Memorial Hospital and former executive director of Mexico's national AIDS agency.

"Are there more cases like this out there? Probably," del Rio tells WebMD. "But if there were a cluster of cases -- five or six people linked by sex who all progressed rapidly to AIDS -- I would be more concerned."

That hasn't happened yet. But in their official report on the patient - in the March 19 issue of The Lancet - Martin Markowitz, MD, and colleagues at New York's Aaron Diamond AIDS Research Center say "the public health ramifications of such a case are great." They also suggest that the findings "raise the specter that this strain of HIV-1 might be especially aggressive," although "the cause of the observed clinical course in this man remains unclear."

But the still-incomplete evidence suggests that the man was especially unlucky, says Eric Daar, MD, chief of HIV medicine at Harbor-UCLA Medical Center in Los Angeles. He was infected with a more-virulent X4 form of HIV that usually arises only after years infection, when AIDS symptoms finally appear.

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