...there’s nothing that suggests this is the beginning of an epidemic...

April 24, 2005 1:09 PM

Updatefilter: Remember all the uproar over the new AIDS superbug? Well, think again. NY Magazine tells all about the "medical panic attack": ... After the frenzy died down, however, the new epidemic began to look a lot less fearsome. In fact, on closer examination, almost everything about this case seems murky. An investigation by the Department of Health turned up no evidence that the New York man passed the virus to anybody. And on March 29, the department put out a press release saying that the patient was responding well to his medications. ... “I thought this sounded familiar, so I Googled ‘superbug’ and ‘AIDS,’” said GMHC’s Gregg Gonsalves. He found two cases reported in 2001 by a noted Vancouver AIDS specialist, Dr. Julio Montaner. The Vancouver Sun quoted Montaner about the cases, but he could have been describing the newest Patient Zero ... March post on it here
posted by amberglow (14 comments total)

That's one way to look at it. There's also:

Gallo and other leading figures in the field—including Dr. Tony Fauci—believe the new case report is a statistically predictable outlier. Unfortunately, drug-resistant HIV is now commonplace: Nearly 30 percent of newly diagnosed HIV cases are resistant to at least one AIDS drug, and 11 percent are resistant to drugs in two or more drug classes.

and

The announcement detonated a long-smoldering debate in the gay community over sexual responsibility. "We are murderers, we are murdering each other," says Larry Kramer. "If intelligent, smart people are unwilling to take responsibility 100 percent for their own dicks, I don’t know how you stop the killing." Some, like the columnist Dan Savage, saw in the case a reason to bring on a new penalty phase for prevention activism. "There’s a great deal of anger and frustration among gays and lesbians at the never-ending, nonstop coddling and compassion campaign that passes for HIV prevention," he says. “There will be no sympathy when this happens to us again. We are not going to be the baby harp seals the way we were in the eighties and nineties. We picked up the same gun and said, 'I hope it’s not loaded this time,' and pulled the trigger again. And I’m gay—imagine how straight people feel."
posted by dhartung at 1:58 PM on April 24, 2005

I think it is important to separate the clinical science at the heart of this story from the political and cultural reaction to it. They should not be confused.

There is no doubt that the case in question is the first time two disturbing characteristics of some HIV-1 viruses -- resistance to most forms of convential antiretroviral treatment and a quick progression to clinical AIDS -- came together in one virus. "Rapid progression to AIDS after acute HIV-1 infection, though uncommon, has been noted, as has the transmission of multidrug resistant viruses. Here, we describe a patient in whom these two factors arose concomitantly and assess the effects," according to Markowitz et al, who did the first study. "The public health ramifications of such a case are great."

At the same time, there is no doubt this case was seized upon by the usual suspects looking to use it as an example of "sex-crazed-homos-spread-death." But dismissing that rhetorical device does not mean you can ignore the public health implications of this new variant -- especially when the individual reported unsafe sexual activity, and there are reports even in the gay press that methamphetamine use is coinciding with unsafe sex.

There are just two things I would suggest to those that would dismiss the reaction to this case as just another example of anti-gay hysteria: You're right. It is an example of that. However, from the very beginning of the epidemic, some leaders in the gay community have resisted calls to change or modify risky behaviour because to do so would limit sexual freedom. Don't forget that ol' Ronnie didn't utter the word "AIDS" until very late in his presidency; and don't forget that some community leaders in San Francisco resisted calls to close bathhouses because they said the new plague was an anti-gay plot by some doctors to rein in newly-won freedoms.

Yes, we should "think again" about the hysteria generated under the headlines of "the new AIDS superbug." But we should also recognize that HIV-1's awesome capability to alter its genetic makeup might likely defeat any pharmaceutical treatment to control its replication or transmission.

(Oh, and on preview: Scientific consensus previously thought that recombinant forms of HIV-1 were statistical outliers until the CRF01_AE recombinant swept Thailand in the early 90s; it's now the dominant subtype in that country's epidemic.)
posted by docgonzo at 2:08 PM on April 24, 2005

drug-resistant HIV has been commonplace for years now, and death rates have been declining, even here in NY.
posted by amberglow at 2:21 PM on April 24, 2005

Did you read my post?

HIV-1 resistant to some antiretrovirals is common; HIV-1 resistant to almost all antiretrovirals (as in this case) is not.

Further, HIV-1 resistant to almost all antiretrovirals that also progresses quickly to AIDS (as in this case), is unique.
posted by docgonzo at 2:27 PM on April 24, 2005

Further, HIV-1 resistant to almost all antiretrovirals that also progresses quickly to AIDS (as in this case), is unique.

Reading the FPP link, it's not clear whether this was a superbug case or not, the way it is written. It seemed to focus more on the writer's view of Dr. Ho's "grandstanding" getting in the way of a clear diagnosis. So is this is superbug or not? Are we just blaming gay men again?
posted by Rothko at 3:39 PM on April 24, 2005

(Which is to say, where is the clinical literature?)
posted by Rothko at 3:40 PM on April 24, 2005

Rothko: I linked to (and abstract of) the only clinical study of the case in my post; I can email you a full copy of the study, with supporting editorial, if you like.
posted by docgonzo at 4:16 PM on April 24, 2005

I chose not to participate in this uproar (I stopped opting in to uproars somewhere around the time of the hanta virus)
posted by Hildago at 5:41 PM on April 24, 2005

Imagine that, the media covering something intended to spread FEAR and blowing it out of proportion. Shocking, really.
posted by nightchrome at 5:56 PM on April 24, 2005

Woo-hoo! I'm going barebacking tonight!
posted by fungible at 6:29 PM on April 24, 2005

So, just one teaspoon of superaids in your butt, and you're dead?
(Sorry)
posted by Citizen Premier at 9:24 PM on April 24, 2005

I thought this was a really good article, all things considered. For the number of times when you get shoddy media going yellow, the ability to be self-critical really helps.
Good post; interesting read.
posted by klangklangston at 11:40 PM on April 24, 2005

"And I’m gay—imagine how straight people feel."

Won't anyone think of the straight people?
posted by axon at 2:06 AM on April 25, 2005

there is no superbug without a bug. hysteria strikes again.
posted by gorgor_balabala at 4:24 PM on April 26, 2005