HEALTH-CARE New HIV strain in NYC poses concern BY BETH SCHWARTZAPFEL

A New York City man in his mid-40s was diagnosed with HIV in December. Since roughly 4000 people were diagnosed with HIV in New York City last year, the diagnosis did not turn heads — until two things happened.

First, in January, the man came back to his doctor, having lost almost 10 pounds and feeling like he had the flu. His infection-fighting CD4 cells (which HIV targets for destruction) had plummeted. Such a rapid progression of HIV is unusual since it generally takes 10 years without treatment before a person progresses to this stage. Then, a relatively routine blood test showed that the man’s virus, though he had never taken any HIV medications, was resistant to three of the existing four classes of treatment. Of the 20 or so available medicines, this man was limited to one, perhaps two.

Amid the flurry of ensuing news reports, the AIDS Action Committee of Massachusetts released a statement that said, "New York, Boston, and Providence are so geographically close and people travel among them so frequently, that news from New York is news for Boston and Providence." What, then, does this mean for Rhode Island?

"I don’t think there is any need to panic right now," says Paul Loberti, state AIDS director at the Rhode Island Department of Health. Individually, "drug resistance, rapid progression to AIDS . . . these things have been on our radar screens for a number of years." It is simply the combination that makes this case unusual.

Dr. Karen Tashima, an associate professor at Brown Medical School, says, "I wouldn’t be surprised if this has been going on and we’ve missed cases." Tashima, who is also an attending physician at the Immunology Center, an HIV care and research center at the Miriam Hospital says, "We have a certain picture of the way HIV affects the body and so we rely on that" (disclosure: I am a research assistant in the Immunology Center’s HIV/hepatitis C Coinfection Program). Therefore, until now, if someone told her that he had a negative HIV test a year ago and now has AIDS — indicating that his disease progressed far faster than typical — Tashima might sooner question the accuracy of the initial negative test, than assume the person had an entirely new strain of HIV. So the first step is to do careful research, she says, and study "the facts of the case . . . We need to learn more about his virus and then we can [determine] if we’ve ever seen anything like it."

The bottom line, says Christopher Butler, executive director of AIDS Project Rhode Island, is that "whether you get a strain of HIV that kills you in six months or 30 years, it’s not something you want to have. Nothing has changed except this person has a lot less options." And while fear can a viable prevention tactic, he says, it fades as a deterrent. "The only reason prevention education worked 25 years ago is because people saw their friends dying," Butler says. With the advent of effective medications, people stopped dying in such large numbers and many who had sworn off sex altogether slowly started returning to their previous behavior patterns. "It’s like Chicken Little," says Butler. In other words, to pretend the sky is falling is not an effective prevention method.

Tashima notes that Centers for Disease Control and Prevention data indicate that, from 2000 to 2003, the rates of new HIV infections among men who have sex with men increased almost 11 percent. "Behavior is hard to change," she says. "It’s just a hard thing."

Health officials in New York City are discussing new measures to track the drug-resistant virus. In Rhode Island, Loberti says officials will consider what changes, if any, need be made to the state’s disease surveillance system. Currently, the state maintains a chronic disease registry, which tracks the numbers of people infected with HIV and other illnesses. Beyond that, the state relies on physicians to alert it to anything new and unusual. This is how New York City officials were alerted to this case in the first place, and in Rhode Island, Loberti says, "That system seems to work very well."