An AIDS case in New York has touched off a pandemic of fear that there's a "super strain" of HIV on the loose, resistant to conventional therapies, that quickly morphs into AIDS. The virus, discovered in a 40-something gay man, a crystal meth user -- his name was not released -- proved resistant to 19 out of 20 antiviral drugs, and progressed from HIV to AIDS within a few months.
News of the case broke Friday and by Saturday New York Mayor Michael Bloomberg was calling on citizens to take precautions to avoid infection. "I think some people thought, 'Well, it's probably not going to happen to me,'" he told reporters. "'And if it does, there are drugs that can stop it, or control it, or let me continue to lead a life.' And that's not true with this new strain."
San Diego public health officials are trying to contact another HIV-positive man whose virus is said to have a similar molecular makeup. And Massachusetts public health officials also report that they've seen cases that have been similarly resistant to therapy.
The case of the "super bug" or super strain of HIV has elicited dire echoes of the early days of the AIDS epidemic. But doctors and public-health advocates caution that it's too early to tell if this is anything new. Julio Montaner, chairman of AIDS research at the University of British Columbia in Vancouver, told the Chicago Tribune that in 2001 he'd identified two patients who had been infected with a strain of HIV that was resistant to nearly every available drug and that spread to AIDS within months. However, the patients turned out to isolated cases and not a public health threat.
Doctors agree, though, that the current scare underscores one important thing -- how the use of crystal meth spurs unsafe sex and the potential spread of AIDS.
"We are encouraging people to not respond in an overblown fashion," says Demetri Moshoyannis, executive director of Being Alive, an organization for people with HIV and AIDS in Los Angeles. "We have no idea right now how this is linked to any kind of broader transmission at all. We've heard about isolated cases before, so I would encourage people not to freak out."
Dr. Jay Levy, one of the first physicians to identify the HIV virus in 1980s, and now director of the Laboratory for Tumor and AIDS Virus Research at the University of California at San Francisco, says it's a misnomer to label the New York case a new strain. "Everybody's virus is somewhat different," he says. Nor is it unheard of for a virus to be resistant to drug treatment. "A virus that's resistant to all three classes of antiretroviral drugs is not new. It's rare but it has been reported over the last three years." What's more, Levy notes, the drug resistance of the newly discovered virus may also not be significant because the results were measured in a lab and not in the patient himself. The patient could be treated with "salvage therapy," he says, where doctors mix a combination of drugs in the body until they achieve the right effect.
Levy, though, was unequivocal about the effects of crystal meth. "If you're a regular user, these drugs have a detrimental effect on the immune system," he says.
Levy's colleague, Dr. Fredrick Hecht, an AIDS researcher at UCSF, doubts that meth use accounts for the rapid development of AIDS in the New York patient. "I don't think it's good for you physiologically but there's not really good evidence that rapid progression would be linked with methamphetamine," says Hecht. "I could give you multiple examples of patients who look like they're doing beautifully, who are using crystal daily. It's difficult to subscribe the rapid progression of the virus to methamphetamine."
However, using crystal meth does raise the odds of HIV transmission in other ways, says Perry N. Halkitis, co-director of the Center for HIV Educational Studies and Training in the Department of Applied Psychology at New York University. Being high on the drug can create "hyper-sexual behavior," increasing the odds of engaging in risky sexual practices. "It disinhibits people psychologically," says Halkitis. "It makes them feel on top of the world, powerful, invincible, and, as a result, really sexually aroused."
Halkitis says that it's been shown that crystal meth users who are HIV-positive, and taking drugs to fight the virus, are likely to skip doses, giving the virus a chance to mutate. Even HIV-positive crystal-meth users who consistently take their prescribed medications often have more of the virus in their body than other patients. ""The use of meth is associated with increased viral replication in the brain, so they have more virus in their body potentially," says Halkitis. "More virus in blood and body means more likelihood of transmission."
Finally, Halkitis points out, there's the health hazards of the "booty bump," slang for getting high on meth through the rectum. "Gay men have been known to insert meth anally," says Halkitis. "If you mix it with water and put it up your rectum, it's called a booty bump. It's caustic to the lining of the rectum. As a result, if you're having unsafe penetration, and your rectum is irritated, you've increased the probability of having something transmitted to you."
While doctors feel that they still don't have enough information -- or cases -- to assess the true implications of the New York case, it's still significant. "This is an important example that bad things can happen," says Hecht. "You can get viruses that are drug resistant and progress rapidly. But I haven't seen anything that convinces me that this is a new virus. Whether he progressed rapidly was due to the virus he was infected with, or due to his own immune system, we're not going to be able to tell from one case."
Levy says the New York case is an important jolt to pharmaceutical companies and medical researchers locked in one area of study. "This should be a wakeup call that we can't put all our energy and attention into drugs that are targeted at certain proteins of the virus," he says. "We've got to look at the other part of the equation, which is the host. Let's try to boost the immune system."
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