aidsmap - New light on the “New York patient”: `super-bug` fears were exaggerated by media

by Derek Thaczuk, Tuesday, April 10, 2007
In early 2005, a gay New York City man was reported to have been infected with an extremely virulent, multi-drug-class-resistant (MDR) strain of HIV, causing very rapid progression to extremely low CD4 cell counts. Public health officials in the city raised the alarm, and US newspapers reported that a new, highly agressive drug-resistant strain of HIV was at large in the city's gay male population.

But now, two years later, the first comprehensive report on the case in a medical journal shows that almost all the initial media - and public health - assumptions about the case turned out to be wrong.

Ongoing analysis of the “New York City patient” has now suggested that he may have been initially infected by a dual-(CXCR4 and CCR5) –tropic virus, rather than having developed it himself, and that the case was highly unusual. The analysis also suggests that his rapid CD4 count drops were associated with primary infection, rather than the extremely rapid chronic infection first reported. The new analysis and commentary are published in the May 1^st Journal of Infectious Diseases.

The original case was extremely well publicised; the most pertinent facts about the NYC patient were as follows:

• Diagnosed HIV-positive in December 2004.

• The date of his infection was not certain, but was no more than 20 months prior to diagnosis.

• He was a heavy crystal methamphetamine user who had frequent, anonymous, unprotected sex.

• He was deemed a rapid progressor and diagnosed with AIDS based on low CD4 cell counts (80 cells/mm³ at diagnosis, 28 cells/mm³ in January).

• His virus was dual (CXCR4 and CCR5) -tropic, multi-drug resistant (although susceptible to efavirenz and T-20), and actually had higher replicative fitness than wild-type (1.38-fold fitter) despite its resistance mutations.

The source of the NYC patient’s infection (the “source patient”) was soon identified. His viral strain was also found to be highly drug resistant, but much less fit (.041-fold compared to wild-type), and apparently CCR5-tropic only. The source patient was not a rapid progressor; he had been on various antiretroviral combinations since 1995.

The source patient’s regular sexual partner was also identified, and found to have been superinfected: he was carrying a recombinant MDR strain of his own original virus (which had been drug-susceptible up until 2001), and the source patient’s.

Two years later: Why did the NYC patient progress so quickly?

Read the rest here.