CONFERENCE QUESTIONS 'SUPER-STRAIN' OF HIV

Experts Unsure If N.Y. Case Is Unique Or A General Threat

Boston -- Two weeks after New York City health officials warned that a
potent new strain of HIV highly resistant to available drugs may have been
detected there, experts at the nation's leading scientific conference on
AIDS were in disagreement whether the presumed new strain represents a
scientific oddity or a public health menace.

To date, the virus has been spotted only once, in an unidentified
46-year-old gay man who reported having hundreds of unprotected sexual
encounters, often under the influence of crystal methamphetamine.

There is no evidence that the virus is readily transmissible, and there is
also uncertainty over whether the bug detected is really a single, highly
resistant strain of HIV, or possibly many subtypes of the virus in the same
patient -- each resistant to some drugs, but not to all.

Dr. David Ho, scientific director and chief executive of the Aaron Diamond
AIDS Research Center in New York, where the patient was treated, posted
details of the case and discussed his findings with reporters and at a
special session devoted to the topic Thursday evening.

Ho created a controversy when his lab turned the data on the new patient
over to public health authorities, which in turn led to a nationwide alert
about the possibility of a new strain -- a move some criticized as premature.

"That is a decision that we stand by today," said Ho, before an auditorium
packed with delegates who skipped previously scheduled sessions of the 12th
Annual Retrovirus Conference to hear this one.

Ho and the New York City health department are concerned that this case
uniquely combines two rare but worrisome traits: viral resistance to almost
all available drugs and the rapid onset of AIDS.

It can take as long as 10 years for HIV to wear down the human immune
system and cause the symptoms of AIDS, but Ho is convinced the New York
patient was infected no more than 20 months ago -- and likely as recently
as October.

The crucial question is whether the aggressive case of AIDS suffered by the
New York patient is the result of something new about the virus, or is
specific to the patient due to his genetics or to behavior that made him
vulnerable.

"I don't think we can readily discern between the two possibilities," Ho said.

He revealed that researchers had already ruled out some of the most common
genetic traits that leave some people predisposed to an early onset of AIDS
after infection. But he said tests are still under way on a dozen other
known traits thought to confer some vulnerability.

Details of the paper show just how sick the man has become: His count of
infection-fighting CD4 white blood cells had slipped to 28 by mid-January
- -- while a count of 800 to 1,000 is considered normal. He has rapidly lost
weight, dropping nearly nine pounds in three weeks, and his level of virus
has soared to a measure of 700,000 particles per milliliter of blood --
indicative of a very robust infection.

Ho, a prominent New York AIDS researcher who is serving as co-chair of the
conference, has been criticized for making too much of a single case, and
also has been praised for promptly warning about the potential threat.

Following the presentation, delegates knew more about the case, but also
learned that more evidence -- and perhaps much more time and research --
will be needed before anyone can draw conclusions.

"It's much ado about an anecdote," said longtime AIDS activist Mark Harrington.

Martin Delaney, founder of San Francisco's Project Inform, remained
skeptical after reading Ho's report, which was printed on a poster
available to all delegates.

"These kinds of cases have been reported before," Delaney said -- referring
to a Canadian doctor's observations of two patients with multidrug
resistant virus and rapid onset of illness, first reported in 2001. "A lot
of clinicians see this stuff, and they don't call press conferences."

Ho said his poster was presented not to reveal any unexpected or new
findings about the case, but to satisfy the intense scientific interest in
details of the case at the meeting here, where 3,900 of the top AIDS
researchers in the world are congregated.

Details within the report describe a patient who became very sick, very
quickly, after binges of unprotected sex and methamphetamines. Ho said that
there is ample evidence that methamphetamine use is associated with
riskier, unprotected sexual activity -- a phenomenon called disinhibition.
There is no evidence, he said, that the drug itself makes the immune system
more vulnerable to infection.

Among the other findings about the case:

- -- The New York patient had his blood tested frequently, five times since
September 2000, but stopped after May 2003. All those tests were negative.

- -- He became ill in early November 2004, and took another blood test in
mid-December, which was positive. He had sex with "approximately" 10
partners from the onset of his illness until the end of December, "when
sexual activity ceased due to his deteriorating health."

- -- Genetic sequencing of the New York patient's virus has shown it does not
match any known strain of HIV contained in a massive database of viral
strains maintained at Los Alamos National Laboratory. Only a few genetic
changes are necessary, however, to define a new strain.

San Francisco AIDS physician Steven Deeks said in an interview that he
believes that "host factors" -- traits of the patient rather than the virus
- -- are almost certainly the cause of his rapid deterioration in the face of
a multidrug resistant virus. However, he said the case still underscores
the danger of unsafe sex in an environment populated by a still-dangerous
virus.

"All the media attention has brought to the forefront what is currently
driving this epidemic: out-of-control methamphetamine use in young, gay
men," he said. "We see this in San Francisco. Twenty percent of patients
with highly resistant HIV are having sex with men known to be HIV negative
or whose serostatus in unknown."

Dr. Harold Jaffe, who headed the Centers for Disease Control and
Prevention's AIDS programs during some of the darkest days of the epidemic
in the 1980s, said there are many unanswered questions about the New York
patient, such as who infected him, when was he infected and whether he has
infected others. The biggest question, Jaffe said is why -- more than two
decades into the epidemic -- some people still practice behaviors that put
them at high risk of infection.

Jaffe said he doesn't think such cases should be used "to scare people"
into safer sexual practices, but that it is correct to make them public.

"The important thing is to put out the facts," he said. "If the facts are
scary, then people will be scared."