Nature 433, 788 (24 February 2005)

New York draws fire over case of drug-resistant HIV

ERIKA CHECK

Rare, aggressive form of AIDS used to publicize dangers of unprotected
sex.

[WASHINGTON] A decision by New York health officials to announce the
detection of an unusually aggressive case of AIDS has led to criticism
from some researchers and activists.

In December last year, a man from New York City tested positive for HIV
and quickly showed signs of AIDS. Doctors at New York's Department of
Health and Mental Hygiene believe that he developed AIDS between 2 and
20 months after he was infected; the disease usually takes about a
decade to develop.

The patient's virus also resists treatment by the three important
classes of HIV-fighting drugs. Officials at the health department say
that this multiple drug resistance and the rapid progression to AIDS
led them to warn the public of the possible spread of the strain. "This
case is a wake-up call," the city's health commissioner Thomas Frieden
told a press conference on 11 February.

Some scientists and doctors have praised the decision to publicize the
case. They hope that it will warn the public about the dangers of
having sex while under the influence of the drug crystal
methamphetamine, or crystal meth. The infected patient had unprotected
sex with many men while using the drug. "My hope is that this news will
bring the reality to the public, and we will see less risky behaviour,"
says Jay Levy, a virologist at the University of California, San
Francisco.

But others questioned whether the information released about the virus
justified the public announcement. Similar cases have been reported
before, critics say, but have not led to epidemics. In 2003, for
example, researchers in British Columbia, Canada, reported two cases of
HIV that seem similar to the New York virus. The Canadian patients were
also infected with multidrug-resistant HIV that rapidly progressed to
AIDS (K. C. W. Chan et al. AIDS 17, 1256-1258; 2003). But these
viruses did not cause a widespread epidemic of HIV 'superstrains'.

"I don't think the health department needed to hang its public-health
campaign on a single anecdotal virus," says John Moore, a virologist at
Weill Medical College at Cornell University in Ithaca, New York.

The virus is being studied by researchers at the Aaron Diamond AIDS
Research Center at Rockefeller University in New York. More data on the
strain are scheduled to be released at the 12th Conference on
Retroviruses and Opportunistic Infections in Boston this week.

But the Aaron Diamond's involvement has also drawn criticism. Some have
even suggested that the centre pushed for the announcement to build
interest in the retrovirus conference, whose programme committee is
chaired by David Ho, the Aaron Diamond's scientific director.

"There's a lot of suspicion because there's a confluence of issues,
including the fact that the conference is around the corner, and David
Ho is its chair," says Richard Jefferys, basic-science project director
at the New York-based Treatment Action Group.

But Ho says that the health department made the call to alert the
public about the virus after consulting with the US Centers for Disease
Control and Prevention in Atlanta, Georgia. Ho adds that his group is
presenting its data in the first available scientifically appropriate
forum - the retrovirus conference. "I'm saddened by people who are
trying to turn this into a personal attack rather than keeping focused
on the case and its public-health ramifications," Ho says.

The health department also defended its action. "We had the necessary
information and we were confident - and remain confident - that the
situation was of great public-health significance," says an official.