Let's take some time today for an important HIV history lesson.
In February 2005 a gay man in New York City was reported to have developed a rare drug-resistant super strain of HIV, and many media outlets, especially the NY Times, and AIDS prevention leaders seized upon the case to sound many loud alarms about risky gay sex, meth use and alleged apathy in the gay community about AIDS. Quite a few mainstream HIV prevention groups used the story to call for more funding and scarier social marketing campaigns, claiming that an epidemic of patients with super HIV was about to hit clinics and hospitals.
I was one of just a few skeptics who questioned the alarm back then, including getting some detailed answers from the NY Times about its sensationalistic coverage. This case generated many fears and stereotypes of the drug-addled, sex-crazed homo and his threat to public health.
One reporter, Duncan Osborne of Manhattan's Gay City News, stayed on top of the story and in August 2006 wrote a superb follow up to the brouhaha of early 2005. From Osborne's story:
Nearly 18 months after it announced the case of a gay man who was infected with a multiple-drug resistant strain of HIV and had rapidly progressed to AIDS, the city health department released a report on the case that reached no conclusions about how the man was infected, if he infected anyone else, or what caused his rapid progression ...
Richard Jefferys, basic science, vaccines, and prevention director at the Treatment Action Group, an AIDS organization, said, “There’s clearly no evidence that this was transmitted on... This idea of a super virus, which created so many headlines, there’s not a single piece of evidence that suggests anything like that.”
Fast forward to today's news about the case, as reported on the AIDSMAP.com site:
Public health officials in the city raised the alarm, and US newspapers reported that a new, highly aggressive 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 newly published report by Gary Blick (the source patient’s physician, who reported on the case at the 2005 IAS conference) and team provides further detail, and advances some possible answers to unanswered questions from 2005.
It now appears virtually certain (from subject interviews) that the NYC patient was infected on October 22, 2004. The NYC patient’s initial AIDS diagnosis and status as a “rapid progressor” were solely based on CD4 counts: he showed no major clinical signs of disease progression other than fever, sore throat, weakness and fatigue, and a 4kg weight loss.
Questions arose at the time as to whether primary infection could have explained the rapid CD4 count drop, as counts often drop dramatically in the first three months after infection, recovering as the infection enters its chronic phase ...
The source patient was also reportedly nonadherent to his antiretroviral treatment, which could potentially have driven the switch in tropism ...
The commentators “believe that existing evidence continues to suggest that superinfection… is uncommon after the first few years of infection, and this report should not lead to the abandonment of serosorting as one strategy to reduce HIV transmission. However, this case is an important cautionary tale that drug-resistant HIV truly can be transmitted to a chronically HIV-infected partner.”
Nice of the AIDSMAP.com folks to note the initial assumptions of the media and public health officials were wrong. Now, I wonder how many newspapers, like the cheer leading NY Times, and TV news outlets and screaming health experts will either do follow up stories or issue further explanations about the report today.
If history is any indication, none will be so brave as to correct the false alarms raised in 2005.
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