It's not happening to other people, elsewhere. It's here.

February 11, 2005 11:34 PM

Drug-resistant HIV strain alarms officials Speculation abounds about the 40something year old man, but doctors think that he had sex with someone who had AIDS and had already developed a resistance to drugs, and then his own crystal meth use created an unkown strain in him. [NYT article]
posted by FunkyHelix (45 comments total)

I don't see how crystal meth would cause mutations, nor can I find any mention of it in the articles. Actually, large parts of the article sound very scare-story-of-the-weeky, though the core of the story is an interesting (and unhappy) development.
posted by fvw at 11:40 PM on February 11, 2005

Agree with fvw. The CNN link's main point concerning meth is merely that it impairs judgement. Nothing about it "creat[ing] an unknown strain in him".
posted by randomstriker at 11:54 PM on February 11, 2005

Well, if you guys want science, unfortunately people have only recently started to look into the connection between meth and HIV, but there is definitely growing interest in the field. I think at this point, it's fair to say that regular crystal meth use in certain populations is associated with driving local HIV outbreaks and transmission, likely because of its cognitive affects.

However a number of studies do suggest that there's more going on. Studies have shown a synergystic neurotoxic affect with HIV and meth perhaps related to the HIV-1 tat protein. In addition (and more specific to this thread), it has been shown that meth's impact on the liver can affect the metabolism of antiretroviral therapies, thereby reducing their efficacy and raising viral loads and infectivity.

Again a lot of the research here is early, but the combination of possible increased "high-risk" behavior, and reduced drug efficacy (which may also contribute to drug resistance) could certainly be a harbinger of trouble to come.
posted by drpynchon at 12:22 AM on February 12, 2005

I'm no doctor, but as I see it, the case was unusual because in this guy (heavy meth user), 1) three out of four known drug treatments seemed ineffective and 2) the disease broke out in a matter of months as opposed to 10 years.

Can't that be explained by him being a drug addict and therefore having a deterioated and highly vulnerable immune system? Or just having a crappy immune system for some other reason besides HIV or meth?
posted by sour cream at 4:31 AM on February 12, 2005

"then his own crystal meth use created an unkown strain in him"

ridiculous statement, and drpynchon says nothing to support it.
posted by telstar at 4:34 AM on February 12, 2005

telstar, I neither support the state nor do I suspect it to be true. That sounds more like the typically poor mass media coverage of scientific matters rearing its ugly head.

I do suspect this is a similar 'strain' as those often found in long-term HAART users, and that poor compliance in a long-term HIV-infected sexual contact who was probably also a meth user potentially played a hand in this. But that certainly doesn't explain why he developed full-blown AIDS so rapidly. Unfortunately there's no case study available in the literature, so trying to filter out the real story through our friends at science-for-dummies is a bit difficult.
posted by drpynchon at 4:53 AM on February 12, 2005

In addition to the state, I also don't support the statement.
posted by drpynchon at 5:00 AM on February 12, 2005

This study found that meth increases the infectivity of the cat version of HIV (called feline immunodeficiency virus) on a type of CNS cell called astrocyte. That relationship could provide a direct mechanistic link between the appearance of novel variants of the virus or more rapid virus transmission and use of meth.
posted by shoos at 5:03 AM on February 12, 2005

not to stifle the needed research in regard to meth use and the hive strain
but they also said in the mid 80's that poppers (nitrates) caused AIDS
posted by halekon at 5:55 AM on February 12, 2005

Halekonn, you must be talking about Peter Duesberg. I think he actually said that AIDS isn't one disease, but a group of similar but distinct conditions, and that these different conditions are all mistakenly attributed to HIV. Poppers are for him just one cause of certain symptoms that lead doctors to say a person "has AIDS."
posted by shoos at 6:29 AM on February 12, 2005

From an epidemiological perspective, wouldn't this be a net gain? I thought that one of the reasons why HIV is such a public health disaster was that it hangs around in a latent but transmissible form for such a long time. With a big gap between infection and the emergence of AIDS, you get plenty of opportunities to spread the infection.

A new form of HIV that morphs quickly into AIDS would cut that time considerably, wouldn't it?
posted by felix betachat at 8:20 AM on February 12, 2005

Clearly the only logical link between meth and AIDs (at this time) is that you simply are less inhibited on crank and are more likely to toss someone without protection. They don't call it PnP (party and play) for nothing.
posted by j.p. Hung at 8:26 AM on February 12, 2005

This article led me to think about those people who were addicted to a type of synthetic heroin that basically gave them Parkinson's disease. Apparently the drug was contaminated with a toxin that went after the nervous system and caused symptoms that were Parkinsonian. Meth could certainly be similar I would think, going after the immune system.
posted by jessamyn at 9:26 AM on February 12, 2005

Felix, this is clearly a case of the devil you don't know versus the devil you do know and can treat. Epidemiologists have been very concerned for quite some time about new strains of HIV that can't be treated. From what I understand, it's very difficult to treat HIV patients who have been reinfected with another strain of the virus.

I've always been pretty low-key about drugs (because I don't like them), but meth seems like a huge public health crisis. Unprotected sex with hundreds-- it's like suicide and genocide rolled into one. Deeply, deeply disturbing.
posted by gesamtkunstwerk at 9:40 AM on February 12, 2005

Outing "Tina".
posted by AlexReynolds at 10:42 AM on February 12, 2005

The Crystal-Meth HIV Connection Resource List.
posted by ericb at 12:04 PM on February 12, 2005

Fenway Health Center Crystal Meth Resource Guide.
posted by ericb at 12:08 PM on February 12, 2005

From an epidemiological perspective, wouldn't this be a net gain? I thought that one of the reasons why HIV is such a public health disaster was that it hangs around in a latent but transmissible form for such a long time.

This was my first impression as well, which supports this report being a lot of hype with no real disaster to follow.

It's interesting that a resistant strain would also be a very fast moving strain because the mechanisms by which the medicines beat the virus involve blocking the viruses' replication system at many different junctions. For a virus to dodge all of these metabolic road blocks, it should be even more latent and insidious. That's how many antibiotic resistant bacteria end up.
posted by Feferneuse at 1:39 PM on February 12, 2005

Simply replace all the occurrences "meth" or variant in the meth scare articles with the words "a witch", and you'll find the key to this latest of many meth scares.

From the "Outing 'Tina'" article:

Darren tells the group he watches a lot of zombie movies. He thinks his fascination with ghouls stems from the similarity between zombiefication and crystal addiction. At first everyone in the group smiles at this observation. So does Darren. Then he enacts the transformation.

and

Many of the recovering addicts on the task force say meth can twist sexual arousal into a kind of psychosis. "If you're on crystal," says one, "you can look at a table lamp and want to have sex with it."

The most amazing thing is that many readers will swallow this nonsense.

Yes, meth can lower inhibitions which can lead to unsafe behavior. But then, if a person is willing to use meth then isn't that a sign a priori that person engages in risky behavior? And as long as we're on the subject of lowered inhibitions, how many can trace their HIV infection to drunken debauchery? Somehow I doubt we'll hear of "alcohol zombies" or drunken sexual arousal from table lamps.

Yes, meth is the current bugbear in the common hysterical mind.
For a real shock, check this out.
posted by telstar at 1:53 PM on February 12, 2005

For a real shock, check this out.

What a bizarre, drive-by trolling.
posted by AlexReynolds at 1:56 PM on February 12, 2005

Yeah, Alex, that is the dirty little secret with the meth hysteria. It turns out that in another context, meth is children's medicine. Same molecule. Same activity. Wierd, huh?
posted by telstar at 2:11 PM on February 12, 2005

Umm different dosing and delivery system. But don't let that keep you from grinding your axe.
posted by drpynchon at 2:27 PM on February 12, 2005

So meth is as safe as a children's medicine? Is that your point? Are you kidding or just high? I don't know why you would want to make such a comparison. It seems pretty empirically available that crystal meth is a very hard drug with drastic effects.
posted by elwoodwiles at 2:27 PM on February 12, 2005

Meth is not only "as safe as childrens medicine", also, apparently, meth is children's medicine. Yes, the dosing and delivery is different. But then, how many of todays meth users learned to like meth in completely different circumstances? I ask how many readers who shudder over the ridiculous meth scares appearing in today's press gladly acquiesce to their own children being given crank or its variants twice a day at school by a registered nurse?
posted by telstar at 2:38 PM on February 12, 2005

thanks for the good links, ericb.

Telstar, dosage and use have a lot to do with how dangerous a drug is, and saying this is just a children's drug is pretty naive. Drugs manufactured on the street aren't like generics, and using a drug for an unintended reason or in doses larger than those recommended pretty much negate any safety testing.
Personally I enjoy wine, but I don't think bing drinking on freeways is really the same thing, do you?

I hope you are right and that this is just hysteria, but these doesn't seem like a reefer madness scenario.
posted by gesamtkunstwerk at 2:48 PM on February 12, 2005

Oops. Should have previewed that.
posted by gesamtkunstwerk at 2:50 PM on February 12, 2005

Telstar's point is worth paying attention to - it's not that meth isn't a dangerous drug, but the same is true of, for instance, alcohol. The point is that it isn't some magical, previously undreamt of kind of high that literally destroys people without their being able to stop it. Just like other drugs, it can ruin some people, and it can have little significant effect on the lives of others. Some people find it useful to admit their 'powerlessness' over whatever addiction they suffer, but that doesn't actually mean that the drug itself can control minds. It means that certain minds find they have to take an all or nothing approach toward the drug and treat it as an enemy, untouchable, just the way alcoholics do with alcohol. But for a lot of alcoholics, the problems run deeper than just the pleasure of a drink.
posted by mdn at 2:51 PM on February 12, 2005

Is nobody clicking the link?

http://www.psyweb.com/Drughtm/desoxyn.html

Methamphetamine ( Desoxyn ) an amphetamine used to treat narcolepsy and attention-deficit-disorder in children. In some cases but rare this drug is used to treat depression. This drug is from a family of drugs known as central nervous system stimulants.

Hey, it's not me saying that meth is a children's medicine.
posted by telstar at 2:56 PM on February 12, 2005

Gotta go with telstar on this. Back in college, I had a roommate who was on desoxyn for ADD. Quite by accident, we figured out that if we crushed up and snorted his pills, we could get a lot of studying done. I had no idea until I read this thread that I'm a recovering meth-head. Mom would be so proud!

In any case, dosage and delivery are not absolutes. Despite the prevailing rhetoric, chemicals are morally neutral entities. It's how they're used and the societal context in which they function that renders them poison or panacea.
posted by felix betachat at 3:03 PM on February 12, 2005

Telstar: We get it. You think meth is ok and akin to prescription medication.

On the other side, meth is having a large, noticeable impact in the gay community with consequences/risks that make all the heretofore messages regarding safer sex, risk reduction, etc seem as though they were mere figments of imagination.

Transmission of resistant virus has been documented, but as far as I know not been as rapid in progression as this particular case. Drug resistant virus is already a big enough problem, but to have this added to the mix is disheartening at the very least.

Personally, I do not wish to return to the days having too few treatment options available and watching those we serve through the practice where I am employed and my personal friends die at the rate they were.

Selfish? Yes. Still a salient point? Yes.
posted by sillygit at 3:09 PM on February 12, 2005

mdn, good points, but those aren't telstar's points. Telstar is basically denying the obvious conclusion that meth is bad for you and then equvicating bathtub street meth with a children' medication.

I realize that the government's war on drugs has created an environment where people deny the anti-drug propaganda. "Reefer madness" was a few billion dollars of the government crying wolf. But anyone who saw the urban crack epidemic of the eighties knows what they are seeing now with crystal meth.

To deny the harmful effects of crystal meth is to be deeply, deeply foolish, at best.

on preview: The 'I was a college meth-head' argument is pretty weak. As you pointed out that "how they are used and the societal context in which they function that renders them poison or panacea" A couple kids in a dorm room is a long way from trying to score in the busmall. The experience of using a drug in one context doesn't tell you anything about its use in other contexts.
posted by elwoodwiles at 3:16 PM on February 12, 2005

You know, just because some dichotomy freaks you out, doesn't mean it's not beyond reason. I've seen 100's of strung out meth-heads at the homeless clinic, and I've rotated through child psych departments where I've seen a much smaller dose of the same drug work wonders (and by the way, methamphetamines are of course 3rd line for ADHD now).

And while there are certainly similarities between crystal meth and alcohol in the context of risk-taking behavior, there are also some fairly concrete differences that I don't think require spelling out.

Look. I'm not going to beat around the bush. While the liberal in me never wants to poke a stick at the gay community, we're essentially talking about a very small-subset of it, doing some very dangerous things. Generally speaking, even ignoring the whole meth thing, for epidemiologists this has always been of great concern (as it should be). Unprotected sex with an HIV+ partner is risky. Unprotected sex with an HIV+ partner who is poorly compliant with his medications may be disastrous. And highly addictive, psychogenic party drugs that may interfere with HIV medications certainly don't help matters.

Of all the things to discount as a scary-story-of-the-week. This is not one of them. I see people die of opportunistic infections regularly enough to vouch for that. And I assure you, they are rarely laughing or smirking at the time.
posted by drpynchon at 3:20 PM on February 12, 2005

drpynchon is correct. I didn't mean to let myself get trolled away from the real subject.
posted by elwoodwiles at 3:27 PM on February 12, 2005

No, actually, I don't think meth is OK.

Having experience with it years ago, today I avoid it, and avoid people who use it.

But I definitely do NOT think that hysteria is helpful. Assigning magical powers to a molecule only makes the problem worse, and leads people to the idea that if they take meth, that all bets are off and any bad or risky behavior they do while on it are to be expected, somehow.

Pointing out that meth is indeed used to medicate children in another context very much highlights felix's very salient point that social cues lead to much of the damage supposedly wrought by morally neutral molecules.

This post, this thread, won't do much to stem the crescendo of meth hysteria that we see in the press today. On the other hand, someone learned today that when he was snorting pharmaceutical-released legally-store-purchased desoxyn, he was actually using meth. My work here is done.
posted by telstar at 3:27 PM on February 12, 2005

This post, this thread, won't do much to stem the crescendo of meth hysteria that we see in the press today. On the other hand, someone learned today that when he was snorting pharmaceutical-released legally-store-purchased desoxyn, he was actually using meth. My work here is done.

I apologize for helping give crystal meth abuse a bad name.

(?)
posted by AlexReynolds at 3:46 PM on February 12, 2005

I, too, have known people who've done meth. It's very, very bad, like other hard drugs. (Of course, all drugs are different, and meth is worse than others in some ways, and not as bad in some ways.) While Telstar makes a few salient points, his attitude seems too cavalier. This story, while a tad hysterical, is not one to ignore.
posted by Tlogmer at 5:06 PM on February 12, 2005

While Luciano acknowledges some people can take crystal once or twice a year and be done with it, he says the unique challenges of life as a homosexual can lead to the insecurity that propels casual use into addiction. And gay society itself is partly to blame.

"I have people come into my office and tell me they're depressed because they're not on the A-list," says Luciano. "This idea that they don't have six-pack abs, they don't make lots of money, they don't get invited to the best parties-I tell them: "What A-list? You're in Philadelphia.' Gay culture, and in part this is because the straight media puts out these images of gay men, is far too focused on material success."

It's much more complex than that, of course, but a good point.
posted by Tlogmer at 5:16 PM on February 12, 2005

As I previously posted, Larry Kramer recently spoke (November 2004) about the "sudden plague of crystal" in the gay community (i.e. my community) during his recent speech at Cooper Union in Manhattan. A worthy read.
posted by ericb at 5:32 PM on February 12, 2005

As someone who researches in the field, this doesn't seem like news. It says that the person's infection appeared new when he was diagnosed in December. Appeared new? There are a couple of never run tests that can guess at how recent an infection is, but knowing for certain is near impossible without seronegative/ seropositive tests being regularly run. Which is sort of acknowledged in the statement:

"In this patient's case, onset of AIDS appears to have occurred within two to three months, and at most 20 months, after HIV infection," the health department's statement said.

The "at most 20 months" is the clue. This strain could have taken 20 months to AIDS. That happens in a percentage of the cases.

And resistant to three out of four drug classes? It depends on how you define drug classes, but there can be more than four. And resistance to one member within a class doesn't necessarily mean resistance to all.

Transmission of resistant forms is not that rare. I would say that at least one resistance mutation appears in about 90% of subjects that I genotype.

Well, I've said enough. I'm in the this-is-overblown group. Unprotected sex and meth addiction can certainly lead to bad consequences. HIV infection and resistance mutations are bad news, as is rapid progression. But it is not new news.
posted by dances_with_sneetches at 7:02 PM on February 12, 2005

Couldn't some of the complications seen with crystal meth use be due to impurities? This is something high-school drop-outs cook up in motels from Sudafed and ammonia-based fertilizer, after all. (Not that abusing "legitimate" pharmaceuticals is a good idea either; some things I've done I discourage my nieces from trying.)
posted by davy at 8:55 PM on February 12, 2005

Couldn't some of the complications seen with crystal meth use be due to impurities?

Yes. Like any street drug, impurities will have some unexpected effects.
posted by vevaphon at 12:27 AM on February 13, 2005

I don't find anything interesting or alarming in this article. It's the same scary shit. HIV, tuberculosis, hepatitis, meth use. I did public health among heavy street addicts in the early nineties, and this CNN article could have been written then. "The rapidly growing crystal-meth epidemic" - bullshit. "Contributing to their concern is the increased popularity of crystal meth, which can impair judgment and heighten sexual sensation."

Yep, that's news.
posted by goofyfoot at 3:08 AM on February 13, 2005

Report on a New Form of H.I.V. Brings Alarm, Not Surprise [New York Times | January 10, 2005]:

"As word spread of a rare and potentially more aggressive form of H.I.V., first reported publicly in New York on Friday, communities already hit hard by the disease, professionals who combat it, and people who are infected reacted yesterday with fear and skepticism. But few were surprised, given that the sense of urgency about the disease has waned."
posted by ericb at 9:46 AM on February 13, 2005

Search for Origin of New AIDS Strain Widens
AIDS viruses from two people are being studied to see if they are the source of a rare form of H.I.V. detected in a New York City man. [New York Times | February 14, 2005]

Gay Users of Internet Play Down Concerns Over New Strain of AIDS
News of a rare and potentially more aggressive form of H.I.V. spread through gay chat rooms, Web logs, dating sites and e-mail. [New York Times | February 14, 2005]
posted by ericb at 7:43 AM on February 14, 2005

correction for above posting:
Report on a New Form of H.I.V. Brings Alarm, Not Surprise [New York Times | February 13, 2005]
posted by ericb at 8:05 AM on February 14, 2005