NYC Health Officials Find New, Virulent HIV Strain
Bloomberg.com 12 February 2005
(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 and Prevention, 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 or 6.75 percent, in
composite trading on the Nasdaq, the biggest single- day percentage
gain since Sept. 10, when it rose 11.49 percent, 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 New York-based 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 patient, whose name was withheld, has symptoms
usually associated "with someone who has very advanced disease,"
he 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 Karlie Stanton, a spokeswoman for the CDC
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.
©2005 Bloomberg L.P. All rights reserved |
