Tests Pending In Cases Tied To Fierce HIV

[jerome]

Tests Pending in Cases Tied to Fierce H.I.V.
By MARC SANTORA

BL Fisher Note:

HIV and most blood-transmitted diseases, like hepatitis B, occur in high
risk adult populations. However, when vaccines are created for these
primarily adult diseases, government vaccine policymakers target innocent
children and make the vaccines mandatory. HIV vaccine will be no different.
It will be the children, whose brains and immune systems are still
developing and who have no voice and have no choice, who will bear the
burden and take the vaccine risk for the risk-taking adults.

Investigators looking into the possible spread of a virulent strain of
H.I.V. detected in a New York City man have identified several patients who
may have a related strain of the virus, but the investigators have cautioned
that they cannot yet say if the cases are connected, health officials said
yesterday.

Because of the complexity of the lab testing involved in matching strains of
the virus, it could be months before health officials will be able to
determine if others have indeed been infected with the dangerous strain, the
officials said.

"The extent to which this strain has spread remains under investigation,"
said the city's Department of Health and Mental Hygiene in its first public
statement since issuing a public warning last month about the man's case.

That warning, on Feb. 11, was provoked by the case of a gay man in his late
40's who engaged in unsafe sex with many partners while he was using crystal
methamphetamine, and whose strain of the virus was at once quickly advancing
and resistant to many drugs. The announcement brought an immediate backlash
from some prominent AIDS researchers who believed that too much was being
made of a single case.

Since that time, investigators have been able to trace all of the sexual
partners the man could remember by name and have now closed that part of the
investigation, said Dr. Thomas R. Frieden, the city's health commissioner.

The effort involved more than half a dozen investigators going door to door,
but Dr. Frieden would not go into detail about how many people were
contacted, citing patient confidentiality concerns. One person briefed on
the investigation said that more than a dozen men were tracked down.

However, because the patient told investigators that he had sex with more
than a hundred people over several months and could not remember many of
their names, the contact tracing is of limited help.

Of those the department has contacted, many were previously infected with
H.I.V., officials said.

"Obtaining blood samples for resistance testing, and testing of these
samples to determine the genetic relatedness of strains is continuing and
may take weeks to months to complete," the department said.

Because the investigation is continuing, Dr. Frieden would not say precisely
how the strains that might be related to the New York City case were found.
Some may have been discovered as a result of identifying men with whom the
New York man had sex, but it is just as likely that they were detected in
the department's canvassing of laboratories that do H.I.V. research and
testing.

In all, one health official said, investigators have identified "fewer than
10" patients whose strains may be related to the New York City man.

Work has already begun, with the help of the Centers for Disease Control in
Atlanta and the Aaron Diamond AIDS Research Center in Manhattan, to sequence
the genome of the possibly related cases, Dr. Frieden said.

The source of the New York man's infection remains unknown, officials said.

Health officials said that his case was particularly troubling because it
was the first in which they had seen a strain of the virus that was both
resistant to nearly all drug treatments and highly aggressive, leading
rapidly from H.I.V. infection to AIDS.

The health department's handling of the case, including the public warning,
came under criticism from some prominent AIDS researchers, who suggested
that the rapid progression of the disease might have more to do with the
man's immune system than the aggressiveness of the virus.

Given the heated reaction and the complexity of the scientific questions
involved, it is not surprising that the department has been cautious in
releasing details about the inquiry.

Still, yesterday's update by the department failed to answer a central
question regarding the case: Did the man transmit this new strain to his
sexual partners?

"As of today, no other cases of multi-drug-class resistant, rapidly
progressive H.I.V. have been identified," health officials said. But that
does not mean that no other cases exist.

The case that set off the alarm involves a man who tested positive for
H.I.V. in December and developed AIDS by January. Investigators say they
believe that he has been infected for as long as 20 months or as little as 4
months. On average, it takes 10 years to develop AIDS after infection, but
the curve is wide, with some people developing AIDS after about 20 years
while others have it progress within a year or so.

The man's virus also showed signs of being resistant to nearly all of the
roughly 20 licensed drug treatments.

Health officials, however, said yesterday that they were encouraged that the
patient seemed to be responding to treatment that includes two licensed
drugs.

"It is probably the most encouraging thing there is about this
investigation," Dr. Frieden said. Still, the man remains seriously ill.

The update by the department comes after researchers at the Aaron Diamond
Center, which alerted the city to the man's case, published a genetic study
of the strain that they said showed it to be unusually aggressive.

But it is the ongoing investigation by the health department in conjunction
with the work being done in laboratories that will ultimately reveal the
strain's significance. It could be months before any definitive conclusions
can be reached, officials said.

In an interview, Dr. Frieden said he remained convinced that the department
made the right decision in issuing an alert.

"It is certainly the case that because we did go public we are more likely
to find future cases as they occur," he said. He also pointed to some
disturbing behavior patterns the investigation revealed.

"The social network surrounding this case indicates that unsafe, anonymous
sex, along with the use of illicit drugs including crystal methamphetamine,
remains common," the department said in its statement.