February 21, 2005
Alarm Over Single AIDS Case Is Challenged by Questioners
By MARC SANTORA and LAWRENCE K. ALTMAN

ew York City's health commissioner, Thomas R. Frieden, had barely
stepped away from the microphone on Feb. 11 after announcing the
discovery of a possibly new and deadly H.I.V. strain when the storm
started. More than a week later, it has not abated.

One group of scientists not involved in the research was quick to
dismiss the news as isolated to one man and unworthy of alarm. Other
scientists said not enough research had been done to warrant a public
health announcement, and accused Dr. Frieden of excessive haste.

Gay activists worried that Dr. Frieden's use of the announcement to
emphasize safe-sex practices would set up gay men as culprits, reviving
a concern as old as the disease. Longstanding rivalries among top AIDS
researchers resurfaced, and one of the researchers who discovered the
possible strain was accused of using a test developed by a company to
which he had close ties.

To those who expect government officials to keep diseases at bay, it
might seem surprising that a public health announcement about a deadly
virus would be attacked, but AIDS is not like tuberculosis or polio.

and profound disagreements among experts, and in recent weeks the virus
seemed to be proving that it could still be treacherous and surprising,
both as a deadly disease and a political fuse.

"The old jealousies, rivalries and big egos," said Kevin Robert Frost,
vice president of the American Foundation for AIDS Research, when asked
why the response was so furious. "Scientists in general react
negatively to news by press conference."

At one level, the reaction illustrates the intense competition among
scientists and their institutions to communicate new findings and get
credit, crucial in obtaining money to expand their research. Many
experts have been involved in the field for years, and in some cases
their professional disagreements have developed into the animosities
and outright personal hatreds that are common in academia.

Nonetheless, scientists, skeptics by nature and training, have a
fundamentally different role than public health officials, who often
have to take emergency measures to stop the spread of disease.

As a result, some research scientists said the appearance of a possible
drug-resistant and virulent strain of the virus in one 46-year-old man
meant little. The man's immune system might have been compromised by
the crystal methamphetamine he had taken, they said, or the virus could
have rapidly led to full-blown AIDS for other reasons that needed
additional investigation before the public was alerted.

"This is a nonstory," Dr. Paul Volberding, director of the Center for
AIDS Research at the University of California, San Francisco, said in
an interview, noting that the pace of change from H.I.V. to AIDS
depended not only on the virus but also the patient. "There have been
many cases of rapid progression. The New York case is only that, a case
report."

But public health officials said that with the battle against AIDS
possibly on the verge of a new phase, where drug-resistant strains
become harder to treat, Dr. Frieden was right to go public. Dr. Alfred
Sommer, the dean of the Bloomberg School of Public Health at Johns
Hopkins in Baltimore, said health officials often did not have the
luxury of waiting for full scientific information before acting.

"For most things we do, we do not have ironclad proof one way or the
other," he said.

Dr. Frieden said that his initial announcement clearly contained
cautions and unknowns, but that his actions were necessary given the
potential public health effects.

"We had enough clinical and scientific information to warrant making
the announcement because of the immediate implications for the
community, and for doctors practicing in New York City," he said.

"We run the risk of either being a dollar short and a day late, or
shouting fire in a crowded theater," said Dr. Michael T. Osterholm,
director of for the Center for Infectious Disease Research and Policy
at the University of Minnesota. "The question is," he said of Dr.
Frieden, "is he a prophet today or is he a prophet 10 years from now?"

The debate is likely to grow louder beginning tomorrow in Boston when
3,800 of the world's top AIDS experts are to meet in a conference to
discuss an array of new scientific findings. Long after the deadline
for submissions of reports had passed, the doctors who handled the New
York City case, Dr. David D. Ho and Dr. Martin Markowitz, asked for a
waiver to discuss the findings about the possible strain they had made
at the Aaron Diamond AIDS Research Center in Manhattan. After much
wrangling, the organizers of the meeting agreed to hold an unusual
special session for the disagreement about the city's announcement.

But scientists were not the only ones upset about the city's actions.
Some gay activists asserted that Dr. Frieden was using the possible new
strain as a scare tactic to get gay men to practice safe sex, an
accusation he denied.

Charles King, the president of Housing Works, an AIDS support group,
said the announcement could be used to demonize the gay lifestyle and
accused Dr. Frieden of having wanted to change regulations regarding
H.I.V. testing for a long time. The Community H.I.V./AIDS Mobilization
Project, based in New York, said the link between the spread of the
possible new strain and the use of crystal methamphetamine was
unproven, and suggested that the city had ignored the "underlying
issues" behind the spread of the virus, like discrimination, poor
housing and unemployment.

"Rather than increasing awareness of the risks of unsafe sex and
crystal use, the Health Department risks stigmatizing gay men as crazed
drug addicts carelessly or wantonly spreading a killer bug," Community
H.I.V./AIDS Mobilization Project said in a statement. "In this case,
the Health Department seems to offer little to the understanding of the
root causes and potential solutions to drug use apart from the
discredited strategy of Nancy Reagan, 'Just say no.' "

Martin Delaney, the founding director of Project Inform, a nonprofit
AIDS foundation, said the city had been needlessly alarmist. "By
pushing this out early, the public health department set off panic
nationwide, before the scientific community had had a chance to see the
scientific data," Mr. Delaney said.

Several gay activists said Dr. Frieden was motivated, in part, by a
close relationship with the Aaron Diamond Center, a charge that city
officials dismissed as ridiculous. The center was created in 1988 to
study the basic science of AIDS as a joint venture of the city's Health
Department, the New York University School of Medicine, and the Aaron
Diamond Foundation, a philanthropic organization. Upon becoming
commissioner in 2002, Dr. Frieden joined the center's board, as had all
his predecessors since the founding of the institution. Health
Department officials say he has no financial interest in the center.

Dr. Ho, then a relatively unknown 37-year-old researcher fresh from
Harvard and U.C.L.A., was hired to run the center in 1989 and
immediately attracted attention. With more money at his disposal than
most other research institutions, Dr. Ho became the object of envy as
top-flight scientists lined up to join his center. Within a few years,
Dr. Ho's team won international publicity, challenging long-held
theories about AIDS and reporting new evidence about the way the AIDS
virus works in the body.

However, Dr. Ho has been criticized for trumpeting findings that other
scientists say later proved wrong. For instance, Dr. Ho and colleagues
strongly suggested, without explicitly stating it as fact, that a
treatment with drug cocktails could cure AIDS by eradicating the virus
from a patient's blood. Since then, it has become clear that the virus
lurks in hidden sanctuaries in the body, making it all but impossible
to eradicate H.I.V. with currently licensed drugs.

Critics have also charged that ViroLogic, the lab that did some of the
testing for the Diamond Center and the Health Department in the most
recent case, is using the case to promote its services. The Monday
after Dr. Frieden's Friday news conference, ViroLogic issued a news
release calling attention to its work performing the test for drug
resistance. Dr. Ho, who was quoted in the release, serves on the
scientific advisory board of ViroLogic. His brother, Sidney Ho, does
marketing work for the company and once was the head of its
communications department.

William D. Young, the chairman and chief executive of ViroLogic, said
there was no effort by Dr. Ho to promote ViroLogic through this case.
He said the company's scientific advisers "are very aware of their
scientific reputations and that's paramount to them. At some times I
prefer them to be promotional but they are not." Mr. Young said
ViroLogic issued the news release to make the public aware of its role
in the testing and its extensive nature.

Dr. Ho said that he has disclosed all of his ties to the company and
that any suggestion of impropriety was false.

After Dr. Frieden disclosed the case, reports of similar cases quickly
emerged, some of which had been published earlier. For example, Dr.
Julio Montaner, a professor of medicine at the University of British
Columbia in Vancouver, reported in 2003 in the scientific journal AIDS
that two men with a highly drug-resistant strain of H.I.V. might have
progressed rapidly to AIDS. Dr. Ho did not contact Dr. Montaner about
the case until three days after Dr. Frieden's news conference.

Dr. Ho said he had searched standard databases for similar cases but
did not find Dr. Montaner's report. After being made aware of the cases
and looking into them, he said there were similarities but also
significant differences. "Our case was much more dramatic in the
history of progression and resistance," Dr. Ho said.

Dr. Ho, for his part, said, he was accustomed to criticism, but
insisted, "We did the right thing in this case."

Andrew Pollack in Los Angeles and Carol Pogash in San Francisco
contributed reporting for this article.