NYC Health Officials Find New, Virulent HIV Strain (Update3)
Feb. 11 (Bloomberg) -- New York City doctors have discovered a man with a previously unseen strain of HIV that is resistant to three of the four types of anti-viral drugs that combat the disease, and progresses from infection to full-blown AIDS in two or three months, the health department said.

``We've identified this strain of HIV that is difficult or impossible to treat and which appears to progress rapidly to AIDS,'' said New York City Health Commissioner Thomas Frieden. ``We have not seen a case like this before. It holds the potential for a very serious public health problem.''

The case was diagnosed in a New Yorker in his mid-40s who reported multiple male sex partners and unprotected anal sex -- often while using the drug crystal methamphetamine.

``It is likely there are others infected with this strain and this individual has infected others,'' Frieden said. The case is ``extremely concerning and a wake-up call,'' he said.

Antonio Urbina, medical director of HIV education and training at St. Vincent's Catholic Medical Center, site of one of Manhattan's largest AIDS clinics, said the patient's use of crystal methamphetamine shows that the drug ``continues to play a significant role in facilitating the transmission of HIV.'' The drug reduces peoples' inhibitions and their likelihood of using condoms or other forms of safe sex, he said.

`Alarming'

While drug resistance is increasingly common among patients who have been treated for HIV, cases of three-class antiretroviral-resistant HIV -- or 3-DCR HIV -- in newly diagnosed, previously untreated patients are extremely rare, and the combination of this pattern of drug resistance and rapid progression to AIDS may not have been seen previously, the health department said in a news release.

The strain found in New York was ``highly unusual,'' said Ronald Valdiserri, 53, deputy director of the National Center for HIV, Sexually Transmitted Diseases and Tuberculosis at the U.S. Centers for Disease Control, in an interview.

``We're talking about a single case, but clearly the fact that we are dealing with such broad resistance of drugs and the rapid clinical progression is quite alarming,'' Valdiserri said.

U.S. health officials intend to contact clinics across the country to set up a surveillance system for the HIV strain, he said. City officials are working to identify, contact and counsel the patient's sex partners, Frieden said.

Fuzeon

Frieden said the one drug the HIV strain isn't resistant to is Enfuvirtide, sold under the trade name Fuzeon, developed by Trimeris Inc. of Durham, North Carolina, and Roche Holding AG of Switzerland. The problem, Frieden and other physicians said, is that this drug is most effective when used in a ``cocktail'' with other retrovirus drugs such as nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors and protease inhibitors.

Trimeris stock closed at $13.60, up 86 cents, the highest it's been since Jan. 11, in composite trading on the Nasdaq, and down $4.63 from $17.93 a year ago. Roche shares traded at 123.2 Swiss Francs, up 0.5 francs, in composite trading in Zurich, down six Swiss Francs from a year ago.

The news ``is probably positive for Trimeris,'' said Sharon Seiler, a biotech analyst with Punk Ziegel & Co., which she said owns no shares in the company, though it does act as a market maker. Fuzeon's required twice-daily injections and the need to mix the solution for 20 minutes ``have been significant impediments to the drug's sales'' in two years on the market, she said.

Fast Onset

The drug, which costs a patient an average $20,000, is the first in a class called fusion inhibitors that work by preventing HIV from infecting healthy cells.

The infected New Yorker had gone for AIDS tests frequently over the years and tested negatively until December, when he tested positive for the virus, Frieden said. Physicians believe he became infected in October.

``In this patient's case, onset of AIDS appears to have occurred within two or three months and at most 20 months after HIV infection,'' Frieden said.

The normal time of progression from infection to full-blown AIDS in an untreated patient is about nine years, with death following within 18 months, said Carly Stanton, a spokeswoman for the U.S. Centers for Disease Control in Atlanta. For someone treated with anti-viral drugs, the average progression to disease from infection is 11 years, with death occurring within an average six years, Stanton said.

Watching for Cases

Doctors at the Aaron Diamond AIDS Research Center in Manhattan diagnosed the patient, Frieden said. David Ho, director of the center, said that while this represents a single case, ``it is prudent to closely watch for any additional possible cases while continuing to emphasize the importance of reducing HIV risk behavior.''

Persons diagnosed and living with HIV/AIDS in New York City totaled 88,479 out of a total population of 7.3 million in calendar year 2003, the last year in which statistics are available.



To contact the reporter on this story:
Henry Goldman at New York City Hall hgoldman@bloomberg.net

To contact the editor responsible for this story:
Edward DeMarco at edemarco1@bloomberg.net.

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This is the worst possible news in the HIV field since 1981.

This is probably the methcillin resistant staph aureus of the HIV world.

This bug mutates at an incredible rate, so in theory at least, this could be an isolated case. But my gut feeling is that it isn't, and we will be seeing a lot more in the weeks to come.

Normally, untreated, it takes upwards of 5-10 years to go from acute HIV infection to the first clinical findings of AIDS. Full blown AIDS three months after infection, with multiple drug resistance, is a setback of unimaginable proportions.

Dr Danny

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Very bad news indeed. However, normally HIV spreads so well because period of latency to full blown aids take so long. But the new bug, may not spread itself so readily because of the rapid onset to major illness. Furthermore the new strain may "burn itself out" because it is such an efficient killer of the "host". I hope I am not coming across as insensitive here, nor do I want to appear to be advocating a careless attitude.

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It's quite true that viruses which kill their host quickly often pose less of a threat -- "less" being a relative term, of course.

This is a nightmare. Yet if the case in question is in fact "patient zero," there is hope for isolation of the new strain.

But I wouldn't bet on it.

All the more reason to PLAY SAFE.

We all need to pay careful attention to this story as it evolves.

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Minor nit pic, but as one of the docs on The Body web site said, there is no such thing as "half blown AIDS".

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