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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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WebMD Health News

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.

"This person is one of the unfortunate few who did acquire this type of virus," Daar tells WebMD. "For reasons not well understood, infection by these X4 viruses doesn't seem to occur efficiently. In all likelihood, that will be the case here as well. So this case is alarming but not novel. The history is reassuring that we are not going to see an epidemic of this so-called superbug."

Del Rio says there is one thing about the case that is absolutely clear.

"This is telling us that AIDS prevention programs have been a failure," del Rio says. "U.S. AIDS prevention is nowhere near where it needs to be. In this country we have an unacceptably high number of people who get HIV every day. We have grown accustomed to this. But it is something we need to be much more aware of. This case should tell us something."

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