From Super Bug to Super Bust

From Super Bug to Super Bust

Nearly 18 months after it announced the case of a gay man who was infected with a multiple-drug resistant strain of HIV and had rapidly progressed to AIDS, the city health department released a report on the case that reached no conclusions about how the man was infected, if he infected anyone else, or what caused his rapid progression.

“Not much there really,” said Julie Davids, executive director of the Community HIV/AIDS Mobilization Project (CHAMP), an AIDS group and a longtime critic of the city’s original announcement. “What certainly isn’t there is any news about other people having accelerated progression or untreatable virus.”

The man, who is in his mid-40s, last tested HIV-negative in May of 2003. He tested positive in December of 2004 and by January of 2005 he had an AIDS diagnosis. It usually takes eight to ten years to progress from first testing HIV-positive to AIDS. The man’s virus was resistant to most of the drugs in three of the four classes of anti-HIV treatments.

The case spawned sensational press coverage with news reports that referred to “super HIV” and suggested that gay men were threatened with a more virulent and drug-resistant strain of the virus.

It also generated great skepticism among AIDS activists and some researchers who emphasized that it was only one person and that cases of new drug-resistant infections and rapid progression had been seen before.

The report answered none of the criticisms or questions raised last year after the case was announced.

The man had no known “genetic host-susceptibility factors” that can cause rapid progression, according to the report, which appeared in the July 28 issue of the Morbidity and Mortality Weekly Report (MMWR), a publication of the federal Centers for Disease Control and Prevention (CDC).

Despite an extensive search, the city found no one who was infected by the man. The city required testing labs across the country to report any cases that matched the drug resistance profile of the New York City case.

The city also took a portion of the man’s viral genes, called a nucleotide sequence, and required labs to report any match to that. The city compared that nucleotide sequence to sequences in databases held by the CDC, the New York state health department, three large U.S. labs, two Canadian labs, and one lab in Europe.

The sequence search yielded three men—one in Connecticut and two in New York City—whose nucleotide sequences were a 95 percent match to the man’s virus. All three were infected before the New York City man. The report noted that investigators could not determine if the three were rapid progressors.

In an e-mail to Gay City News, the health department press office wrote, “One match does not appear to have been a rapid progressor,” and that the other two may or may not have been.

There was a “strong likelihood” that the man and one of the three had had sex, according to the report. He may have had sex with all three.

“Although none of the three patients with matching genotypes identified each other or the index patient by name, all reported engaging in sexual activity at the same events or venues or at similar events attended by the index patient during the preceding two years,” the report read.

While this suggests that the man was infected with at least two HIV strains, the report said, “Investigators were not able to determine exactly when or how… the index patient was infected… or whether the index patient’s viral genotype was from a single viral infection or from recombination or superinfection.”

Infections with more than one strain are associated with rapid progression. In a June 2005 medical journal article, Geoffrey S. Gottlieb and David C. Nickle, two University of Washington researchers, raised the possibility that such an infection was responsible for the New York City case. In an e-mail, they declined to comment.

As of July 21 of this year, the man and “two of the patients with matching genotypes were clinically stable and responding” to treatment. The third matching genotype patient was lost to follow up.

At least some of the data in the report had been published earlier in press and scientific articles. For those who were initially skeptical, the MMWR report was a final vindication.

“On the science side of it, the most critical question is whether this was a super virus or just a dual infection case,” said Dr. John P. Moore, a professor of microbiology and immunology at the Weill Medical College of Cornell University. “I don’t see any proof that the super virus really existed.”

Richard Jefferys, basic science, vaccines, and prevention director at the Treatment Action Group, an AIDS organization, said, “There’s clearly no evidence that this was transmitted on… This idea of a super virus, which created so many headlines, there’s not a single piece of evidence that suggests anything like that.”