Aaron Diamond’s lead researcher says lack of a second case does not alter his conclusion
Roughly a year after disclosing the case of a New York City gay man who was infected with multi-drug resistant HIV and rapidly progressed from being HIV-positive to an AIDS diagnosis, the researcher who reported that case to the city health department said that while he continues to believe that a single strain of HIV caused the man’s disease progression, there is much about the situation that remains unknown.
The disclosure led to widespread media speculation about the rise of a so-called super-virus.
“Personally, I believe that it is his virus,” said Dr. Martin Markowitz, a researcher at the Aaron Diamond AIDS Research Center, in a January 9 interview. “We have generated data that says that this virus grows differently than other viruses. We are trying to find what those determinants are… There are studies of this virus that suggest it is unusual in its characteristics.”
Markowitz will present that data at a February AIDS conference in Denver. While the man’s physical make-up may have contributed to his disease progression, Markowitz said that his data did not support that conclusion.
“We have ruled out all the known host factors that are associated with rapid progression,” he said in a second interview on January 10. “The operative word there is known.”
The possibility that the man may have been infected with more than one strain of HIV—such dual infections or super-infections are associated with rapid disease progression—has not been ruled out, but neither has it been shown to be the cause of the man’s disease.
“I would say that based on what we found in this patient, the viral population was extremely homogeneous and did not appear to be two different viruses,” Markowitz said. “It’s very difficult to rule out dual infection and super-infection. We don’t find evidence of it, but we can’t rule it out.”
The health department, which did not respond to a request for comment, announced the case last year in a February 11 press conference. The press coverage was filled with stories about an “AIDS Super Bug,” and a “frightening, never-before-seen super-strain.”
Some researchers and many AIDS activists challenged the science behind the case and objected to the health department making a high profile announcement based on a single case. They noted that similar cases had been reported previously, that infections with drug-resistant HIV were increasingly common, and that the man’s rapid progression could be due to causes other than the virus.
Dr. Thomas R. Frieden, the city’s health commissioner, defended the announcement saying the man, a crystal user, had many sex partners and the city was presented with the possible spread of a virulent, multi-drug resistant AIDS virus. In an interview with Gay City News in December, Mayor Michael Bloomberg backed up his health commissioner’s decision to go public last February with news of the man’s illness.
The man’s last negative HIV test was in May of 2003. In November 2004, he experienced flu-like symptoms, which can occur when one is first infected, and he tested HIV-positive on December 16, 2004. In January 2005, he received an AIDS diagnosis. It usually takes years to go from being HIV-positive to having AIDS.
Given that the man had “many, many, many contacts and put a lot of people at risk,” as Markowitz put it, the fact that no second case has been found tends to undercut the assertion that the man’s rapid progression was caused by a single virus.
The man cooperated with the health department’s sex contact tracing work and the department made a concerted effort to find additional cases. Last year, Frieden ordered 39 labs across the country to give his department data on any multi-drug resistant HIV cases they tested that matched or were similar to the virus that infected the New York City man.
In July 2005, the health department reported only that it had found three men, all gay, who were infected “with strains of HIV that are equally closely related to the strain of the case announced in February.” At least one of those men had been infected before the New York City man.
On January 9, Markowitz said he did not know why no second case had turned up.
“I don’t know the answer to that,” he said. “Even though he engaged in numerous contacts his viral load may have been low enough so that he didn’t transmit. He may have infected someone and we haven’t found it yet.”
It may be that the virus in the New York City man is less effective at infecting others or the majority of the man’s sex encounters may have happened before he was infected. In a follow-up conversation on January 10, Markowitz said, “Frankly I’m surprised there aren’t more cases. I can’t tell you why there haven’t been other cases. I think it’s surprising.”
The activists who challenged the announcement last year see the absence of a second case, let alone an outbreak, as a vindication of their objections.
“It’s important to recognize that a panic-based approach was used to spread speculative information about something that has not materialized,” said Julie Davids, executive director of the Community HIV/AIDS Mobilization Project, based in Manhattan.
With “no epidemic or a verified second case… I think the health department should have careful and detailed accounting of what we’ve learned and issue a retraction,” Davids said.
In an e-mail, Richard Jefferys, basic science project director at the Treatment Action Group, another Manhattan-based AIDS organization, criticized the health department for last year’s press conference and for its failure to disclose more data later.
“Can’t help but note that the health department was eager to have community stand with them at their initial ill-conceived press conference, then sought a welter of information from labs around the country, but when it comes to sharing information that they have? Not so great,” Jefferys wrote. “I get the sense that they are simply hoping that everyone will forget the whole story.”
Dr. Martin Markowitz, a researcher at the Aaron Diamond AIDS Research Center, continues to believe a single and new strain of HIV caused a gay man to rapidly progress from HIV infection to AIDS, with resistance to many available treatments, despite the failure to date to find others similarly infected.