The announcement from New York health officials in early February was chilling: A single patient had progressed from HIV infection to AIDS in months rather than years, and his strain of the HIV virus seemed impervious to normally effective medicines.
The patient, a gay man in his 40s, had unprotected anal intercourse with scores of partners. Headlines of a potential new killer spread around the world.
“This case is a wake-up call,” Dr. Thomas Frieden, New York City’s health commissioner, said at a news conference where he issued a warning for physicians to prepare for a possible new phase in the epidemic.
Yet several AIDS experts immediately questioned the importance of the case and the strategy of publicizing it so widely.
Months later, those doubts seem to have been confirmed.
No super-strain has emerged. The patient, whose name has been withheld, has responded to drug therapy. No one – not even the man’s known sexual partners – was found to be infected with the same HIV strain.
Some AIDS specialists now say the New York announcement was scientifically naive and needlessly alarmist – risking the effectiveness of future prevention efforts.
“Does it do good to (mislead) people and exaggerate?” asked Dr. Robert Gallo, co-discoverer of the virus that causes AIDS. He condemned Frieden’s far-reaching conclusions as “scientifically, completely invalid, without a shred of evidence.”
Frieden and Dr. David Ho, director of the Aaron Diamond AIDS Research Center in Manhattan, where much of the patient’s lab work was done, declined interview requests.
But Frieden recently defended his decision in a letter to the journal Annals of Internal Medicine.
“We did not issue an alert to cause fear, nor do we think this was the primary result of our announcement,” Frieden wrote. “It would not have been appropriate to await additional cases before making an announcement. The goal of public health is to prevent, not describe, outbreaks.”
The patient’s condition did seem to encompass a frightening confluence of factors.
The presence of HIV in the patient’s blood reached high levels and essential immune system cells were severely depleted within 20 months after he was infected, rather than the typical several years. Three of the four major classes of antiretroviral drugs proved ineffective.
The patient was a user of methamphetamine, an illegal drug that loosened inhibitions and could suppress immune response.
The seriousness of the alert was bolstered by the stature of the doctors behind it, some of whom were among the most respected in AIDS research. Ho, Time magazine’s 1996 Man of the Year for his AIDS work, lent a stamp of scientific certainty.
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