Okay...this LBN article just ticks me off!

[Liberal Veteran]

NYC Health Officials Find New, Virulent HIV Strain

Feb. 11 (Bloomberg) -- New York City doctors have discovered a previously unseen strain of HIV, which appears to be resistant to three of the four types of anti-viral drugs that combat the disease, and progresses from infection to full-blown AIDS in two or three months, the health department said.

``We've identified this strain of HIV that is difficult or impossible to treat and which appears to progress rapidly to AIDS,'' said New York City Health Commissioner Thomas Frieden.

Frieden said the case, diagnosed in a man in his mid-40s who reported multiple male sex partners and unprotected anal sex -- often while using the drug crystal methamphetamine -- was ``extremely concerning and a wake-up call.''

Antonio Urbina, medical director of HIV education and training at St. Vincent's Catholic Medical Center, site one of Manhattan's largest AIDS clinics, said at a news conference that the patient's use of crystal methamphetamine shows that the drug ``continues to play a significant role in facilitating the transmission of HIV.''

http://www.bloomberg.com/apps/news?pid=71000001&refer=&sid=aDEfEZh52ykY


My comments:

It is extremely unlikely that this virus "magically" mutated in such a way to be resistant to all PI's, NNRTI's, and NRTI's on it's own. That encompasses several mutations. In other words there is no SINGLE mutation that confers resistance to all those drugs.

That means that people who know they are HIV positive and are currently on antiviral therapy are engaging in unsafe sexual activity and passing it along.

I don't know if it's a breakdown of patient education or if it is willful negligence, there is no excuse for people who are HIV positive to be engaging in unsafe sexual behavior.

[xchrom]

1. but people do and people always will.

that's human nature.
most will play according to the rules.

and by the way -- the virus is ALWAYS mutating even if you have sex with NO ONE.

this isn't the only drug resistant strain out there.

[Liberal Veteran]

8. Of course it isn't, but almost all NNRTI/NRTI/PI resistance...

...occurs because of selective pressure from being exposed to antivirals. Even though the virus is mutating all the time, resistant virus never becomes the dominant virus in the body unless it is subjected to antivirals.

Indeed, when people go off antivirals because of resistance, the wild-type non-resistant virus becomes the dominant strain once again.

That's why it's highly unlikely that this strain was just some random freak mutation (even though in the truest terms ALL MUTATION is random) that happened to infect this individual.

It has already been established that people are passing around resistant strains of the virus, but this one is particular interesting because it's resistant to specifically 3 out of 4 classes of antiviral and just oddly the one it isn't resistant to happens to be the newest class that very few people are currently taking. That's lends support to the idea that people who are HIV+ and know they are because they are taking antivirals are engaging in unsafe behavior.

It is a warning flag that we cannot ignore.

[Brian_Expat]

11. Amen, amen, amen

I cannot say it often enough you have hit the nail ON THE HEAD in this post.

[beyurslf]

2. They have been talking about the development of "super" strains of HIV

for a number of years now. The fact that this is emerging was really only a matter of time.

It does not have to be directly from someone who knows he is HIV+ either. Say person A has never been tested but regularly has unprotected sex. He has sex with person B, C, and D. All 3 are + and all 3 have one form of the resistant strain. Person A could develop a resistance to all 3 forms and pass this on to person E. Person would have the "super" resistant strain, be tested, and find out he is +. He would not know it is the resistant strain until meds failed.

[Liberal Veteran]

5. Well too be honest, the meds shouldn't be successful at all in that case.

Which is why most doctors these days who treat HIV will run a genotyping and phenotyping test to check for resistance prior to initiation of therapy.

It is extremely risky to put a person on combination therapy without doing resistance testing. If for example, your strain is resistant to NNRTIs and you put the patient on Epivir/AZT/Sustiva, then it's highly likely that you will not suppress the virus enough and risk further mutation to the NRTI branches of the therapy which could effectively ruin any chance of a long-term HIV suppressive therapy because essentially, you have put the patient on Epivir/AZT since the efivirenz is not effective.

Of course that's beside the point. Somewhere along the line, SOMEONE or multiple someone's are likely engaging in high-risk behavior who knew they were HIV positive to begin with somewhere down the chain of sexual partners.

[slutticus]

3. HIV does mutate on it's own very quickly, however,

I don't think many people know that HIV can actually combine its genome with other strains of HIV to produce a new strain.

It pains me to think that people who are already infected may believe that they can't get infected again. They may very well be producing very virulent, resistant strains.

[Ian David]

4. Isn't it unusual for a virus to suddenly kill so much faster?

Usually, viruses evolve over time to something that can live in a host indefinitely without killing it.

An AIDS virus that kills within months runs counter to the genetic interests of the virus. A virus that takes longer to sicken and kill gets to infect more hosts.

This is different from becoming more drug-resistant.

This is a drastic shortening of the viruses window of opportunity to infect new hosts.

But this doesn't sound natural to me.

Not being a virologist, I could be wrong.

[Liberal Veteran]

6. Well, yes and no.

Wild-type HIV virus (non-resistant) generally can take up to a decade before the person becomes symptomatic.

Selective pressure comes into play in the presence of antiviral therapy. The virus that mutates in such way to be able to reproduce properly in the presence of a specific antiviral drug will likely become the dominant form of virus over in the host.

That's why we do triple (or more) therapy in the hope that if the virus mutates in a way to be resistant the other two drugs can keep it from replicating. When one drug in the combo fails completely and replication takes place anyway, then the virus further mutates to try to get past the next drug.

Oddly though, if removed from therapy altogether, a person with drug resistance will revert to wild-type being the dominant virus which indicates it is more viable than the mutated drugs to some extent. Once the selective pressure of the drug is returned, the drug resistant virus will become dominant once more since it never truly goes away.

[xchrom]

9. none of the drugs taken for hiv are good forever.

i know people{well, dead now} who were taking the cocktail{s}, did fine for a while then {not so} gradually the drugs failed -- the virus found it's way around them.

that's the nature of this beast. it doesn't happen often -- but it does happen.

the reason why we so despeartely need a vaccine{?} is that human behavior and the virus nature are unpredictable.

a certain percentage of the population is going to play unsafe -- with that percentage going up -- obviously during uptakes in recreational drugs.

the only sure fire way to combat episodes like this is to stay engaged with the community -- constantly reeducating people and finding newer and more effective ways of engaging each new generation.

but nothing is going to be bullet proof until we crack the code of the skin of the virus -- and that's it.

[Liberal Veteran]

12. I agree to an extent.

With proper adherernce (which is VERY hard) an effective drug combo can last quite a long time, perhaps even decades (although it's really too soon to know).

But that's the rub, the kind of adherence that is needed for that is extremely difficult. My particular combo has worked for 5 years to keep my viral load undetectable, but I'm kind of obsessive-compulsive anyway and of course I still get nerves whenever it's bloodwork time again (which rolls around on Monday for me).

But all that is truly beside the point. In truth, effective antiretroviral therapy is showing the other side of the double-edged sword that it is.

It was really easy to drive the message home in the 80's and early 90's when everyone knew someone dead or dying of AIDS.

The three big problems that are facing the community in this as I see it:

1) Convincing people the problem is real and that they need to engage in safer sex every single time when people aren't dropping like flies.

2) Countering the message of those groups who believe HIV disease is a myth (ie, the very vocal groups ACT-UP SF and the various chapters of HEAL in every major city).

And of course the one that is probably going to be the most controversial:

3) Supporting laws that make it a criminal act to knowingly engage in unsafe sex when you are HIV+. That may sound harsh, but the simple fact is that the most likely reason for resistant strains being spread throughout the community is people who are not taking precautions knowing they are positive. Scientists warned us about this particular danger. And to be honest, if you are engaging in unsafe sex when you know you are positive, you are recklessly endangering people's lives. While it doesn't absolve the uninfected person of responsibility, people who know they are HIV positive have a responsibility to not spread the virus.

[Corkey Mineola]

16. good mix of public health science and logic

I concur with the idea that recreational drug use (esp alcohol) fuels the epidemic.

This seems rather abberant (this virus type...) Whether it's a harbinger... well that remains to be seen.

[dsc]

7. Both scary and sad

People should know better than this. I hope to God this isn't as bad as it seems.

[Brian_Expat]

10. The sad thing is. . .

. . . there will always be people out there who will say barebacking is no big deal and that we as gay men have no real role in changing our behaviour to halt the spread of the virus. :(

[Duncan Grant]

13. Let's not forget about the vast majority who are sexually responsible.

Thanks for posting this Liberal Veteran! My comments aren't directed toward you but to the LGBT community here at DU. :thumbsup:

As someone who has done HIV prevention work for years and years I find these stories disturbing for all of the reasons mentioned in this thread.

A point I want to make is about how this article doesn't acknowledge the vast majority who are not "tweakers" who report multiple sex partners and unprotected anal sex.

How come we never hear about the men who do live 'responsible' vibrant sex lives? God forbid that gay men get the idea that their sexuality is healthy, fun, affirming, and completely devoid of 'dirtiness'. It saddens me to see gay men vilify others based on the actions of so few.

My gay/bi brothers, you can have healthy, responsible and vibrant sex lives. You are not sexual pariahs. :loveya:

edit: word choice

[sundog]

14. thanks

nice to have a post that isn't a harbinger of doom & gloom :)

[Liberal Veteran]

15. And that's the way we need to spread the word.

Spread the word on how to fun, healthy, safer sex.

If we go into this trying to tell everyone they have to pick a partner and be completely monogamous forever, we are going to set ourselves up for failure. I can't see that being any more effective than the "astinence based sex-ed" programs that the righties are pushing which are failing miserably.

[sundog]

18. yup

<If we go into this trying to tell everyone they have to pick a partner and be completely monogamous forever, we are going to set ourselves up for failure>

Thanks.

[Corkey Mineola]

17. right on!

Well said 94114.
Our public health meausures and strategies HAVE YET to embrace a sex-positive, holistic approach to gay men's sexuality and well-being. This article is evidence of the disease-model reigning supreme. I'm less interested in a wild new killer virus than in the thousands of gay deaths from substance use, suicide, accidents, untreated depression, etc. Not to mention heart disease and cancer in later life. We are puppets of the CDC and the infectious disease docs.
Cut the strings!

:kick:

[Bluebear]

19. Some perspective from a noted HIV physician

As a sidenote, the media couldn't wait to paint a gay man as a strung out multi-hundred partnered sex freak, could they?

=====

Dr. Joel Gallant, MD MPH, Associate Professor of Medicine, Johns Hopkins University School of Medicine, Division of Infectious Diseases
Medical Director, Johns Hopkins Moore Clinic
Director, Garey Lambert Research Center
Editor, The Hopkins HIV Report.


I'm a little surprised that this is being talked about as something new. We've known for years that you can be infected by resistant virus, and there have been cases described in which people have been infected by virus that's essentially resistant to all drugs. The difference here is that this patient progressed to AIDS very rapidly. I haven't seen all the details of the story, but I doubt that we can be sure that his rapid progression was a definite consequence of the resistance of the virus. In many cases, people who progress rapidly do so because of their own genetics rather than due to characteristics of the virus. In addition, by talking about a new "strain" of the virus, the implication is that the virus being transmitted in the community is evolving en masse, which is not the case. This unfortunate individual was in the wrong place at the wrong time (or moe likely in many wrong places many, many times) and picked up a resistant virus from someone who had developed highly resistant virus as a result of therapy. It doesn't mean that the standard wild-type virus out there today is worse than it was 10 years ago....

[Duncan Grant]

20. Great point about the media!

Amazing how fast people jump on the "multi-hundred partnered sex freak" bandwagon, isn't it? Thanks for posting this Bluebear. :yourock:
edit: clarity

[Bluebear]

23. It doesn't surprise me in the least

I first heard about this on CSpan this a.m., that's how I found the Dr. Gallant quote I cited.

The CSpan woman was breathlessly reading the story from the NYT with the pertinent sexy parts highlighted in yellow. I could hear the freepers clucking from here about those promiscuous gays and how they 'all' must take part in this 'lifestyle'.

Of course, I always want to counter the arguement, you don't want them to marry, yet you don't want them to have more than one partner, WHICH IS IT you hateful 'holy' pieces of crap?

[Stepup2]

24. This is the rub imo

I have lost many friends over the years and have many who are praying the cocktail won't fail them.

The social messages are enough to make anyone rip out their hair and imo contribute to unsafe behavior.

We are not supported, our relationships are not supported, our families are not supported, the hetro monogamous realtionship is held us as the ideal. And when we make strides towards the parity in social status or legal protections, the stool gets kicked out from under us again.

In a town near my home, an entire generation of men is gone. All the social support networks that existed are gone. The negative messages may contribute to the anomie younger people may be feeling, which may contribute to unsafe behavior.

This country has a hard time talking about straight sex, let alone gay sex.

[Liberal Veteran]

21. Well, that was in part some of the intent of my first post.

While the speed of progression from infection to AIDS with this is debatable at this point, as it is just as likely that this person had already screwed up his immune system through a lot of drug use, the fact remains that the multidrug resistance part of this particular strain is no subject to debate and it sends up warning flags that the medical community has been warning us about for years.

[Brian_Expat]

22. Exactly right

All along the medical community has warned that protease inhibitors and reverse transcriptease inhibitors would only slow the progress of the HIV virus for a while and that true victory would require prevention that would allow HIV to "burn out."

Instead, too many people are viewing the cocktail and things like "undetectable viral load" as a sign that "AIDS is over so go out and party." Then, eventually, the virus mutates to overcome the latest drugs and you're stuck with a virulent super-HIV that spreads through populations that otherwise might have been OK.

[Moloch]

25. Viruses can mutate!

I have no knowlege of virology or anything of that nature but I did see Outbreak...

It pisses me off too that people who know they are positive like to spread the disease, but there is no reason to blame the messenger.