Health Commissioner Frieden won’t comment on ongoing investigation
Saying it could be weeks or even months before the city knows if others are infected with a strain of multi-drug resistant HIV currently carried by one New York City gay man, Dr. Thomas R. Frieden, the city’s health commissioner, defended his department’s decision to go public with the news of the one infection.
“We did not make this announcement to increase fear,” Frieden said at a March 3 town meeting sponsored by the HIV Forum. “We made this announcement because we felt we had a responsibility.”
The New York City man was first diagnosed as HIV-positive in December of last year. His doctor referred him to the Aaron Diamond Research AIDS Research (ADARC), which is studying people who are newly infected, where testing showed that he was resistant to many AIDS drugs. ADARC contacted the health department with the news in late January.
“Our decision process in this was: Is this real? Is this a real phenomena?” Frieden said. “We were skeptical about it.”
Frieden said that when the health department concluded that that the case might be “a harbinger of increasing drug resistance,” he called a February 11 press conference to announce the findings. He said that may have prevented other infections.
“I think our going public with it made it less likely that it will be widely disseminated,” Frieden told the audience of roughly 350 that gathered at the Fashion Institute of Technology.
The decision to go public has been widely criticized given that only one case so far has been identified. Frieden declined to discuss results from the health department’s efforts to find the man’s sex partners who may be infected with the virus.
“As soon as we have information that we are reasonably confident is valid, we will release it,” he said. “I will not give any information on an ongoing investigation.”
The health commissioner noted the “understandable controversy” that surrounds the case and added, “I think there is understandable concern that we don’t know more.”
As more information has come out about the case, it has grown less compelling than it originally seemed and the discussion at the March 3 forum continued that trend.
Dr. Lawrence G. Hitzeman, an attending physician at Cabrini Medical Center who works with the man’s doctor, told the crowd that the man’s viral load, a measure of the amount of virus in his blood, went from over 600,000 to 4,000 after being treated with four AIDS drugs.
Hitzeman told Gay City News that the drop was “significant,” but it could take three to six months to determine if his response to treatment is “durable.”
The man’s T cell count, a measure of his immune system health, is still very low at 48 and he is being evaluated for pneumonia, Hitzeman said. A normal T cell count ranges from 700 to 1,200.
Press reports have characterized the bug as resistant to three of the four classes of drugs used to treat HIV, but ADARC data, presented at a Boston conference on February 25, suggests the virus is resistant to all of the drugs in two of those four classes with susceptibility to some drugs in the other two classes. The man is being treated with drugs from those two classes.
The crowd also learned new details about the man who is in his 40s. He was a meth user, though never a meth injector, who took the drug about once a month over the past five years, Hitzeman said. During that time he was a top during anal and oral sex.
“He was the insertive partner,” Hitzeman said. “He was the top.”
In 2004, his meth use escalated to every weekend and he had an October sex encounter where he was the bottom. He may have been infected then which would mean that he rapidly progressed from being HIV positive to having AIDS, a diagnosis he received in January. It typically takes years to go from being HIV-positive to having AIDS.
The man’s last negative HIV test was in May of 2003. Whether he progressed to AIDS in four months or 20 months, he is still a rapid progressor, though it remains unclear if the man or the virus is the cause.
Dr. Moupali Das-Douglas, a special assistant to Frieden, told the crowd that the case was a “wake-up call” to gay men, meth users, AIDS groups and healthcare providers.
“We at the health department thought it was irresponsible not to inform the public,” said Das-Douglas, who spoke before Frieden arrived. “We really think the spread of this virus is a serious health problem.”
The third panelist during the meeting’s first part was Dr. Daniel Boden, an ADARC researcher, who presented data on the case.
The second part of the forum featured panelists from five AIDS and gay groups who each briefly discussed HIV prevention, drug-resistant HIV and other topics.
The March 3 meeting was the seventh produced by the HIV Forum, a group founded by Dan Carlson and Bruce Kellerhouse, since late 2003 and, like earlier meetings, the state of HIV prevention was a central topic.
Tokes M. Osubu, executive director of Gay Men of African Descent, said the announcement of the multi-drug resistant HIV case made him angry.
“My anger stemmed from the feeling that someone who had survived the devastation of 80s and the 90s had sero-converted,” Osubu said. “It makes me angry because, as a provider, I felt that we had failed.”
George Ayala, director of the Institute for Gay Men’s Health, a joint project of the Gay Men’s Health Crisis and the AIDS Project Los Angeles, said HIV prevention was falling short.
“I don’t agree with the idea that prevention is broken,” he said. “I think our ideas about prevention are broken. Our prevention ideas are defined more and more narrowly.”
The other panelists were Therese R. Rodriguez, executive director of the Asian and Pacific Islander Coalition on HIV/AIDS, Jay Laudato, executive director of the Callen-Lorde Community Health Center, and Dennis deLeon, president of the Latino Commission on AIDS.
The panel was moderated by Paul Schindler, the editor of Gay City News. 12