Return to Previous Page

Update on Investigation of a Rare Strain of HIV in a New York City Resident

29 Jul 2005

NEW YORK CITY — The New York City Department of Health and Mental Hygiene (DOHMH) last updated the public on the investigation of a patient with a rare strain of multi-drug-class resistant HIV on March 29. (nyc.gov/html/doh/html/pr/pr026-05.shtml). Recent media reports of a presentation by a physician not affiliated with DOHMH (Dr. Gary Blick of Norwalk, CT) have raised questions about the ongoing investigation. At present, we know the following:

The source of infection for the patient announced in February cannot be determined with available information. At this time, DOHMH has identified 3 people (including the one described by Dr. Blick) with strains of HIV that are equally closely related to the strain of the case announced in February. All four individuals are men who have sex with men. Laboratory investigations and investigations of the clinical course of illness of these patients are continuing. Any of these patients, including the one described by Dr. Blick, or other patients who are as yet undiagnosed or unreported, could be the source. Given the complexity of the investigation, we may never know.

With respect to the case DOHMH announced in February, it is possible that the individual's innate immune system played a role in rapid progression of the illness. However, the patient has been tested for all known factors that predispose to rapid progression and has not been found to have any of them. Testing of the virus indicates that it has characteristics that may correlate with rapid progression. Therefore, although it is not possible to rule out innate characteristics as a cause of the rapidly progressive course of the patient described in February, characteristics of the virus strain itself are at least as likely to be the cause.

The possible window of time between infection and illness in the patient described in February remains 4-20 months. The investigation remains ongoing to determine whether there will be other cases diagnosed and reported in the future. Had February's announcement not been issued, DOHMH would have had no ability to determine the extent of spread of the strain.

It continues to be critically important to redouble HIV prevention programs to reduce the spread of all strains of HIV, which remains - at this time — an incurable disease.

Public Health Messages

• Safer sex is crucial. Unsafe sex, especially among men who have sex with men, continues at unacceptably high levels. Increased condom use is essential; New York City organizations wishing to order free condoms and lubricant from the Health Department can do so online at: http://www.nyc.gov/health/condoms.
• The proportion of HIV-infected patients with drug-resistant isolates has continued to increase. Doctors caring for HIV-infected people should promote treatment adherence by simplifying regimens and ensuring access to mental health and substance abuse services and housing. People being treated for HIV should adhere to their medication regimen to live a longer and healthier life.
• Doctors should routinely offer HIV counseling and voluntary testing, and should consider the diagnosis of acute retroviral syndrome among people who have risk factors for HIV and present with flu-like symptoms, fever, swollen glands, sore throat, rash, muscle aches, diarrhea, headache, nausea and vomiting. People with acute HIV are very infectious because their viral load (amount of HIV in the blood and body fluids) is high.
• People at risk for HIV should learn their status so that they can access treatment if they are infected and also take steps to prevent transmission of the virus to others.

http://www.nyc.gov/html/doh/html/pr/pr076-05.shtml