On Friday, New York City health officials issued this chilling announcement: A man is infected with a form of the AIDS virus that is not only resistant to three of the four classes of anti-HIV drugs, it is apparently so virulent that it causes full-blown AIDS in a matter of weeks rather than the usual decade or more. It will be super-difficult to treat, and it may be a super-fast killer.
New York City Health Commissioner Thomas Frieden first heard of the case on Jan. 22. Tests showed that the man had been infected for only a short time.
Frieden prudently had samples of the mysterious virus assessed by two independent labs. Both labs confirmed that it is resistant to all three of the classes of pill-form HIV drugs and that it attacks its victims with what are called CX4 cellular receptors, which are typically found only in those infected with HIV for a long time and in advanced stages of AIDS.
There is more bad news. The man is the victim of another U.S. epidemic methamphetamine use. While high and uninhibited, he had sex with more than 100 men over the last two years, often without using a condom. And he recalls little about those encounters certainly not the partners' names and addresses. There is little hope of tracing the virus, of studying the strain's transmission, of warning the victim's partners or stopping them from having more unprotected sex.
Frieden's warning on Friday was exactly right: "This is a wake-up call." AIDS isn't tamed, and it certainly isn't defeated.
Still, it didn't take long for the naysayers to appear. Dr. Robert Gallo, co-discoverer of HIV, called the announcement "irresponsible and outrageous." Other HIV scientists insisted that Frieden was wrong to issue an alert because highly mutated viruses are wimpy bugs they must surrender their powers of transmission to become drug- resistant. Still others insisted that it was biologically impossible for CX4 viruses to spread widely: Unless the city could prove the new HIV strain had been transmitted, the alarm was inappropriate.
Such reactions are hogwash. Denial and silence are the true dangers.
In 1981, all too many doctors and scientists ignored a Los Angeles report of six cases of strange pneumonia in gay California men. "What's the big deal with six sick homosexuals?" many said to me then. That was the birth of AIDS, which has now killed more than 25 million people and currently infects 40 million to 50 million.
All new epidemics, or novel trends in familiar microbes, start small. And the New York City case fits into a larger pattern. An ever-increasing number of people in the wealthy nations have been getting infected with drug-resistant strains of HIV since treatment drugs were introduced in 1996.
By 2002, scientists at UC San Diego reported that more than 22% of new infections in gay Americans involved forms of HIV that could resist one class of the drugs, and about 10.2% could resist two classes. Those figures have been climbing steadily.
Obviously, lots of men who know that they are HIV-positive are taking the medicines, having sex without condoms with men who aren't infected and giving them their mutant viruses. Most of those resistant viruses can still be treated because treatment requires a combination of drugs and the ones that are still effective can be mixed to work. In contrast, with three of four classes of drugs out of the picture in the New York case, there is no good treatment option available.
It's possible, as some of the naysayers assert, that the mutant virus will prove to be only weakly transmissible from person to person. And perhaps the extremely rapid disease progression seen in this one patient is not because of the virus itself but because of the particular individual's unusually susceptible immune system.
But we don't know any of that for sure. In the meantime, did the New York City Department of Health, acting in consultation with the Centers for Disease Control and Prevention, do the right thing by alerting the world to this case? You bet it did.
Drug companies need that wake-up call. They should be working more quickly to create new and different HIV drugs.
Advocates of widespread distribution of the drugs that do exist and I count myself among them need the wake-up call as well. However desperate the need, the more people in countries worldwide who get access to HIV drugs, the more mutant viruses will be produced. Without effective, funded safe-sex education programs, widespread distribution of drugs could make the epidemic worse.
And those who use methamphetamines and prowl for sex certainly need the wake-up call. Denying the risk of AIDS won't make the virus disappear.
We can't keep pretending that resistant forms of HIV will always be clinically weak, or that widespread use of HIV drugs will not promote evolution of new, much-harder-to-treat forms of HIV. We can't tell our public health officials that we would simply rather not know the bad news about AIDS.