New York Times Friday Feb 11:
" Arare strain of H.I.V. that is highly resistant to virtually all anti-retroviral drugs and appears to lead to the rapid onset of AIDS was detected in a New York City man last week, city health officials announced on Friday.
It was the first time a strain of H.I.V. had been found that both showed resistance to multiple drugs and led to AIDS so quickly, the officials said. While the extent of the disease's spread is unknown, officials called a news conference to say that the situation is alarming.
"We consider this a major potential problem," said Dr. Thomas R. Frieden, the commissioner of the New York City Department of Health and Mental Hygiene. The department issued an alert to all hospitals and doctors in the city to test all newly detected H.I.V. cases for evidence of the rare strain.
The virus was found in a New York City man in his mid-40's who engaged in unprotected anal sex with other men on multiple occasions while he was using crystal methamphetamine. Health officials have long said that the drug's stimulating effect and erasure of inhibitions contributes to sex marathons that have increased the spread of H.I.V.
The man, whose name was not released to protect his privacy, is believed to have had unprotected sex with hundreds of partners, according to one person briefed on the case who insisted on anonymity because the investigation is continuing.
Some AIDS specialists outside New York City expressed skepticism about the alarm, believing that it might be an isolated case related to the patient's immune system. But Dr. Frieden said the case heightened the importance of using condoms.
"This case is a wake-up call," Dr. Frieden said. "First, it's a wake-up call to men who have sex with men, particularly those who may use crystal methamphetamine. Not only are we seeing syphilis and a rare sexually transmitted disease - lymphogranuloma venereum - among these men. "Now we've identified this strain of H.I.V. that is difficult or impossible to treat and which appears to progress rapidly to AIDS."
While H.I.V. strains that are resistant to some anti-retroviral drugs have been on the rise in recent years, both in New York City and nationally, city and federal officials said that the new case was worrisome for several reasons.
The viral strain in the unnamed patient was resistant to three of the four classes of drugs used to treat H.I.V. from the start of treatment. Typically, drug resistance occurs after a patient is treated with retroviral drugs, often because the patient veers from the prescribed course. And more often than not, a person is resistant to only one or two classes of drugs.
But in this case, the drug resistance is combined with a rapid transformation into AIDS. Both of those phenomena have been seen before, but are not believed to have occurred together.
"What's unique about this is the combination of multiple drug resistance and a rapid course," said Dr. Ronald O. Valdiserri, the director of H.I.V./AIDS prevention at the Centers for Disease Control. "To folks in the public health community, that is a particularly dangerous combination." He said that while it was an isolated case at this time, the C.D.C. had informed other health departments around the country out of concern.
Dr. David Ho, the Director of the Aaron Diamond AIDS Research Center, which did the testing that identified the rare strain, described the convergence of the two problems as "a scary phenomenon."
But not everyone agreed. Dr. Robert C. Gallo, a co-discoverer of the AIDS virus and director of the Institute of Human Virology at the University of Maryland, was very skeptical of yesterday's announcement.
"My guess is that this is much ado about nothing," he said. "Though it's prudent to follow it, I don't think it's necessary to issue a warning or alert the press."
Dr. Gallo said that it was well known that some patients progressed from initial infection to AIDS very rapidly, but that it was usually because they were highly susceptible, not because the virus was virulent. He said that this case, in which the virus is drug-resistant and the progression rapid, was rare but not necessarily alarming.
Dr. John P. Moore, an AIDS researcher at Cornell University's Medical School, agreed.
"If there was a cluster of these, that would be different," he said. "But I wouldn't get bent out of shape about what is literally an anecdotal case right now."