Doctors warn of virulent HIV strain in wake of New York case

DOCTORS yesterday sounded a new warning over a virulent multi-drug resistant strain of HIV that can trigger full-blown AIDS within four months of infection.

The virus was discovered at the end of last year in a man in his late forties who had unprotected sex with numerous other men.

Public officials in New York are now trying to trace the man's partners while scientists carry out genetic studies on the virus.

The researchers wrote in the Lancet medical journal yesterday: "The intersection of multi-drug resistance and rapid development of AIDS in this patient is of concern, especially in view of his case history. The public health ramifications of such a case are great."

The case prompted New York health officials to hold a press conference and issue a special alert to physicians in the area.

It also highlighted the growing threat posed by an HIV epidemic fuelled by the stimulant crystal methamphetamine. The drug, also known as "ice" or "glass", is especially popular within the club and gay scene.

Dr Martin Markowitz, from the Aaron Diamond Aids Research Centre,

New York, who heads the team looking into the case, said: "Only additional investigations will reveal whether this case is isolated or not.

"Irrespective of the outcome, efforts to prevent HIV-1 transmission need to be intensified, with particular emphasis on the epidemic that is being propelled by the use of metamphetamine.

"However, in doing so, care should be taken to avoid punitive measures against the populations most vulnerable to HIV-1."

The patient tested HIV negative in May 2003, yet began to feel ill in November last year.

A new test a month later showed he was infected. Doctors estimate he succumbed to AIDS in no more than four to 20 months.

It usually takes 10 years or more for HIV infection to progress to AIDS, which occurs when the body's immune system collapses.

The patient has not responded to treatment with three of the four major classes of drug used against HIV. This combination rapid progression to AIDS together with multi-drug resistance is highly unusual.

Normally, a virus that becomes drug-resistant pays a price that makes it less virulent. But in this case the virus seems, if anything, to be extra aggressive.

The researchers said they were still trying to establish why the transition from HIV infection to AIDS was so rapid.

"The cause of the observed clinical course in this man remains unclear," they wrote.

In an accompanying editorial, the Lancet said: "This case serves as a reminder that HIV remains a frighteningly versatile foe, one that can mutate to escape immune attack or to acquire drug resistance with surprising speed.

"One lesson to be drawn from this case, therefore, is that despite all the advances that have been made in understanding this virus, and all the progress that has been made in developing new drugs, prevention remains the most effective strategy to combat HIV, especially prevention efforts that target high-risk groups, such as men who have sex with men, intravenous drug users, and sex workers and their clients."