March 7, 2005

The case of a New York City resident who was diagnosed with a rare strain of multi-drug resistant HIV that rapidly progresses to AIDS_first revealed publicly in a February 11, 2005 press release issued by the New York City Department of Health and Mental Hygiene_has attracted considerable media attention and continues to stimulate active debate among public health officials, medical researchers, and the AIDS community. The case has caused alarm for the following reasons:

• The patient has a highly virulent strain of HIV that is resistant to three classes of the most commonly prescribed drugs used to treat HIV. It is extremely rare for this strain to be found in individuals who, like the New York resident, have never undergone antiviral drug treatment.
• The patient developed AIDS within an estimated two to three months after initial infection with HIV (the virus that causes AIDS). Normally, it takes an average of ten years after initial infection with HIV for individuals to develop AIDS.
• The combination of the highly virulent drug-resistant strain and the rapid onset of AIDS in one individual is thought to be unique.
• The patient is a male in his mid-40s who reported multiple male sex partners and unprotected anal intercourse, frequently while under the influence of crystal methamphetamine (crystal meth).

Public health officials fear that this rare, highly virulent strain of HIV may spread rapidly in the context of a growing epidemic of crystal meth use among men who have sex with men. The drug lowers inhibitions and can lead to frequent unprotected sex with multiple partners, greatly increasing the risk of transmitting HIV. Some gay activists, on the other hand, have criticized the New York City Department of Health and Mental Hygiene's response as premature and fear that the media attention to this HIV "superbug" may further stigmatize the gay community.

However, there is general agreement that this individual case of HIV_whether it is an isolated case or whether it signals a deadly new phenomenon_should lead to heightened awareness about the dangers of HIV infection and continued emphasis on the prevention of new cases.