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my big book of little catastrophes
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new HIV strain 
12th-Feb-2005 09:07 am
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http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2005/02/12/MNG8ABA7RK1.DTL

A new strain of the AIDS virus that swiftly causes disease and resists virtually all anti-HIV drugs has been detected in New York City, causing health officials there to issue a nationwide alert through the federal Centers for Disease Control.

AIDS clinics and health departments throughout California already have been notified of the single case, but no evidence of the new virus strain has been reported anywhere other than New York, specialists monitoring the disease said.

In San Francisco, Dr. John Greenspan, director of the AIDS Research Institute at UCSF, said Friday that all community physicians and city clinics treating HIV or AIDS patients have been informed of the New York case. But because the new virus strain has been detected in only one person so far, he said it is "very unlikely" that it would reach beyond the urban center where it was found.

"It's a new warning, however, that safe sex practices remain the most effective way of preventing any HIV infection," Greenspan said.


The article doesn't speculate on the origin of this resistant and aggressive strain, but I have my own thoughts on the matter. I've been expecting something like this for years. Seems like the accepted things is that if you are poz you can bareback with other poz men, and no one worries because they are already infected. Combine people on different drug therapies with lots of poz men barebacking and you get a breeding ground for resistant strains. I'm not up on the research, but last time I checked there was documentation for reinfection and superinfection.

I wonder how long until a resistant strain starts to spread and antivirals become broadly ineffective.
Comments 
12th-Feb-2005 06:16 pm (UTC)
still sad to hear. and somewhat disappointing that the NYC folks are so certain that this will remain contained.
12th-Feb-2005 07:09 pm (UTC)
The use of medications means that there will always eventually be a strain that overcomes all medication... especially with such a fast mutating virus like HIV.

Also, though I DO NOT think everyone that contracts HIV is an idiot, I do believe that the same idiots that get it through PnP and other arrogant idiocy and/or lack of education are the same ones that think once they're poz it's over and they can fuck other poz people without concern. Idiocy, I tell you. I have a friend that I very much respect who is also poz, and he made it very clear to me that even with his current long-term partner (several years) they still use condoms because there's no telling if the strains they have are the same. They're educated, informed, and learn the lesson the first time.

This is unfortunate, but not surprising. I would even say, it was inevitable.
12th-Feb-2005 11:44 pm (UTC)
Interestingly, the patient is reported to have first tested positive for HIV just this past December. While this information may be anecdotal, it does limit the possibility of the strain emergence due to co-infection/superinfection (as when an already positive person becomes infected with a separate strain). In my estimation, this strain is probably just a very lucky (or unlucky in the case of the patient) random mutation of an already resistant strain. The novel element is not just the resistance, but the extreme pathogenicity of the virus, causing the patience acceleration to AIDS within months.

Resistant strains are already spreading, that's a known fact. In an ironic sene, much like with antibiotics, resistance evolution is driven primarily by our current therapies. You keep hitting a hyper mutable virus like HIV with the same set of drugs without killing it completely, it WILL adapt. My hope is that a strain like that described in the article is fairly self-limiting - after all, a virus needs to keep the host alive long enough to replicate and spread. If such a virulent strain emerges, and kills its victim too quickly, it never has a chance to spread effectively.

13th-Feb-2005 05:31 pm (UTC) - Alternative hypothesis - treament adherence
Interesting hypothesis. While what you propose is certainly within the realm of possible, the evidence suggests that the rates of re-infection via barebacking is scant. The original, and vivid, news stories that came from the Ottowa research paper in 1998 were later found to be based on flawed data - the supposed re-infection strain samples had been contaminated. The couple's HIV strains turned out to have distinct genetic sequencing after all.

From POZ: Fast-forward to August 2001, when Salyer and company got their follow-up from Bob Grant, MD, of the University of California at San Francisco's prestigious Gladstone Institute of Virology. After replicating lab research on patients A and B, Grant announced his findings at the CDC's annual HIV prevention conference. This time, not only did each of the two men's virus look strikingly less alike than before, but when gene sequences -- likely contaminated -- used in the Ottawa round were eliminated, there was no evidence at all that either patient even had drug-resistant virus. "The data was insufficient to prove that reinfection had occurred," Grant says. "As nearly as we can tell, the Ottawa case was not a case of superinfection."

There is a more parsimonious hypothesis based upon what we've learned from over two decades of antiviral treatment and drug adherence.

I posit that superstrains result from poor drug treatment adherence. HIV has lived within human hosts for decades now. With the many drug treatments thrown its way coupled with a reasonably high number of folks with detectible viral loads, the virus has had a diverse environment in which to replicate and mutate. By trying various drug regiments in series, those with poor drug adherence ultimately become resistant to all of the available therapies. This is fairly common and the emergence of their drug-resistant strains involves having sex with no-one. It is simply a byproduct of poor treatment adherence. Have this occur enough times and a "superstrain" very well could evolve via mutation.

I believe that the biggest driver of HIV mutation is poor drug adherence.


13th-Feb-2005 06:22 pm (UTC) - Re: Alternative hypothesis - treament adherence
That's a good point. I hadn't heard that newer information. But the question remains, how do these resistant strains get passed on? If someone is not sticking to a drug regimen (required for your hypothesis), that means they know they are poz, and are still out barebacking and infecting other people. I know there are a lot of complex issues involved with how people get infected, but I still find it hard not to hold someone responsible who knows he his poz and continues to indulge in such behavior. Poor drug adherence could be blamed on forgetting to take meds, not being able to deal with the side effects, and any number of other things. Not putting on a condom seems to be less easy to explain away.
14th-Feb-2005 05:14 am (UTC) - Re: Alternative hypothesis - treament adherence
I agree with that. The responsibility goes two ways, of course. Except in extraordinary circumstances, it takes two people making a poor judgment for transmission to occur...not just one.
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