"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. "We have not seen a case like this

before. It holds the potential for a very serious public health problem."

The case was diagnosed in a New Yorker in his mid-40s who reported multiple

male sex partners and unprotected anal sex - often while using the drug

crystal methamphetamine.

"It is likely there are others infected with this strain and this individual

has infected others," Frieden said. The case is "extremely concerning and a

wake-up call," he said.

Antonio Urbina, medical director of HIV education and training at St.

Vincent's Catholic Medical Center, site of one of Manhattan's largest AIDS

clinics, said the patient's use of crystal methamphetamine shows that the

drug "continues to play a significant role in facilitating the transmission

of HIV." The drug reduces peoples' inhibitions and their likelihood of using

condoms or other forms of safe sex, he said.

'Alarming'

While drug resistance is increasingly common among patients who have been

treated for HIV, cases of three-class antiretroviral-resistant HIV - or

3-DCR HIV - in newly diagnosed, previously untreated patients are extremely

rare, and the combination of this pattern of drug resistance and rapid

progression to AIDS may not have been seen previously, the health department

said in a news release.

The strain found in New York was "highly unusual," said Ronald Valdiserri,

53, deputy director of the National Center for HIV, Sexually Transmitted

Diseases and Tuberculosis at the U.S. Centers for Disease Control, in an

interview.

"We're talking about a single case, but clearly the fact that we are dealing

with such broad resistance of drugs and the rapid clinical progression is

quite alarming," Valdiserri said.

U.S. health officials intend to contact clinics across the country to set up

a surveillance system for the HIV strain, he said. City officials are

working to identify, contact and counsel the patient's sex partners, Frieden

said.

Fuzeon

Frieden said the one drug the HIV strain isn't resistant to is Enfuvirtide,

sold under the trade name Fuzeon, developed by Trimeris Inc. of Durham,

North Carolina, and Roche Holding AG of Switzerland. The problem, Frieden

and other physicians said, is that this drug is most effective when used in

a "cocktail" with other retrovirus drugs such as nucleoside reverse

transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors

and protease inhibitors.

Trimeris stock closed at $13.60, up 86 cents or 6,75 percent, in composite

trading on the Nasdaq, the biggest single- day percentage gain since Sept.

10, when it rose 11.49 percent, and down $4.63 from $17.93 a year ago. Roche

shares traded at 123.2 Swiss Francs, up 0.5 francs, in composite trading in

Zurich, down six Swiss Francs from a year ago.

The news "is probably positive for Trimeris," said Sharon Seiler, a biotech

analyst with Punk, Ziegel & Co., which she said owns no shares in the

company, though it does act as a market maker. Fuzeon's required twice-daily

injections and the need to mix the solution for 20 minutes "have been

significant impediments to the drug's sales" in two years on the market, she

said.

Fast onset

The drug, which costs a patient an average $20,000, is the first in a class

called fusion inhibitors that work by preventing HIV from infecting healthy

cells.

The infected New Yorker had gone for AIDS tests frequently over the years

and tested negatively until December, when he tested positive for the virus,

Frieden said. Physicians believe he became infected in October.

"In this patient's case, onset of AIDS appears to have occurred within two

or three months and at most 20 months after HIV infection," Frieden said.

The patient, whose name was withheld, has symptoms usually associated "with

someone who has very advanced disease," he said.

The normal time of progression from infection to full-blown AIDS in an

untreated patient is about nine years, with death following within 18

months, said Carlie Stanton, a spokeswoman for the U.S. Centers for Disease

Control in Atlanta. For someone treated with anti-viral drugs, the average

progression to disease from infection is 11 years, with death occurring

within an average six years, Stanton said.

Watching for cases

Doctors at the Aaron Diamond AIDS Research Center in Manhattan diagnosed the

patient, Frieden said. David Ho, director of the center, said that while

this represents a single case, "it is prudent to closely watch for any

additional possible cases while continuing to emphasize the importance of

reducing HIV risk behavior."

Persons diagnosed and living with HIV/AIDS in New York City totaled 88,479

out of a total population of 7.3 million in calendar year 2003, the last

year in which statistics are available.

Originally published on February 11, 2005

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