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AIDS Experts Awaken to a False Alarm

A warning of a virulent new strain in New York didn't pan out, and the messengers feel the heat.

June 05, 2005|Charles Piller | Times Staff Writer

The announcement from New York health officials in early February was chilling: A single patient had progressed from HIV infection to AIDS in months rather than years, and his strain of the HIV virus seemed impervious to normally effective medicines.

The patient, a gay man in his 40s, had unprotected anal intercourse with scores of partners. Headlines of a potential new killer spread around the world.

"This case is a wake-up call," Dr. Thomas R. Frieden, New York City's health commissioner, said at a news conference where he issued a warning for physicians to prepare for a possible new phase in the epidemic.

Yet several AIDS experts immediately questioned the importance of the case and the strategy of publicizing it so widely.

Months later, those doubts seem to have been confirmed.

No super-strain has emerged. The patient, whose name has been withheld, has responded to drug therapy. No one -- not even the man's known sexual partners -- was found to be infected with the same HIV strain.

Some AIDS specialists now say the New York announcement was scientifically naive and needlessly alarmist -- risking the effectiveness of future prevention efforts.

"Does it do good to [mislead] people and exaggerate?" asked Dr. Robert Gallo, co-discoverer of the virus that causes AIDS. He condemned Frieden's far-reaching conclusions as "scientifically, completely invalid, without a shred of evidence."

Frieden and Dr. David Ho, director of the Aaron Diamond AIDS Research Center in Manhattan, where much of the patient's lab work was done, declined interview requests.

But Frieden recently defended his decision in a letter to the journal Annals of Internal Medicine.

"We did not issue an alert to cause fear, nor do we think this was the primary result of our announcement," Frieden wrote. "It would not have been appropriate to await additional cases before making an announcement. The goal of public health is to prevent, not describe, outbreaks."

The patient's condition did seem to encompass a frightening confluence of factors.

The presence of HIV in the patient's blood reached high levels, and essential immune system cells were severely depleted within 20 months after he was infected, rather than the typical several years. Three of the four major classes of antiretroviral drugs proved ineffective.

The patient was a user of crystal methamphetamine, an illegal drug that loosens inhibitions and might suppress immune response.

The seriousness of the alert was bolstered by the stature of the doctors behind it, some of whom were among the most respected in AIDS research. Ho, Time magazine's 1996 Man of the Year for his AIDS work, lent a stamp of scientific certainty.

The February announcement included caveats about assuming too much from a single case. But scientific uncertainty can be a hard sell to the media, and the event seemed suffused with the subtext that this could be a turning point in the epidemic.

Hundreds of articles and broadcasts followed. Some took a hysterical tone -- perhaps an overreaction by media outlets that were criticized for ignoring early cases of AIDS more than 20 years ago.

"New AIDS Super Bug -- Nightmare Strain Shows Up in City," trumpeted the New York Post. "New AIDS Peril Puts America on High Alert" was how the Hindu, one of India's large national newspapers, played the story. The New York Times headlined one of its several stories: "Chilled by Findings, Investigators Dreaded the Mounting Evidence."

The problem, however, was that for many experienced AIDS workers, none of the conditions was new or particularly rare.

Dr. Douglas Richman, director of the Center for AIDS Research at UC San Diego, said resistance to three classes of AIDS drugs was relatively common.

"Rapid progression occurs in a subset of people," said Richman, lead author of a study that showed widespread drug resistance similar to that of the New York patient's. "High rates of promiscuity among men who have sex with men, especially those who abuse methamphetamines, is frighteningly high."

"I didn't see this as a new, master virus that posed a threat of a new epidemic," Richman said.

Gallo, director of the Institute of Human Virology at the University of Maryland, said the New York officials might have jumped to the conclusion that a single virulent infection would be easily transmitted.

The infection might say more about the individual's susceptibility to the virus than about the virus' ability to spread easily.

Canadian researchers Dr. Julio Montaner and Richard Harrigan at the British Columbia Centre for Excellence in HIV/AIDS detected two similar cases in 2001, and those patients apparently did not pass along the virus.

"It wasn't clear that there was a real public health benefit from the way the announcement was made, as opposed to investigating more details in advance," said Dr. Paul Volberding, director of the Center for AIDS Research at UC San Francisco.

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