Questions and Answers with NAM n Keith Alcorn, senior editor, NAM
HIV super-strain
I’ve heard there’s a new super-strain of HIV that is resistant
to all the drugs available.
It’s true that one case of HIV infection resistant to virtually all
the drugs on the market, except T-20, efavirenz and delaviridine, has been
detected in the US. There’s also evidence this drug-resistant strain
of HIV caused very rapid damage to the immune system, leading to an AIDS diagnosis
within 18 months of infection.
However, it’s still unclear if the individual who developed Aids so
quickly had any risk factors that might explain his rapid progression. We
still don’t know enough about his genetic profile, for example. Some
people have a genetic profile that makes them less likely to develop Aids
quickly. What we don’t know is whether there are genetic profiles that
could make some people develop Aids more quickly after infection with this
type of HIV.
We also know little about how widely this virus has been transmitted in the
US. Much of the information about this case has filtered out via sensational
newspaper stories, and the hard work of following chains of infection through
laboratory testing is still going on.
I heard that this case was linked to drug use - did that have any
impact on how dangerous this virus might be?
A number of infected men who appear to be linked were users of methamphetamine,
a very potent form of speed that is widely used by gay men in the US and beginning
to become more common in London. There’s speculation that the virus
may have been passed on in sex clubs or saunas where methamphetamine is commonly
used, but this doesn’t mean that use of the drug had anything to do
with the virus’s virulence.
The real problem with methamphetamine is how horny it makes people - horny
enough to keep having sex with different people for days, in some cases. It’s
an ideal aid for spreading any sexually transmitted infection if condoms aren’t
being used and if Viagra is thrown in.
Has the superstrain reached Europe yet?
We have no idea whether this virus has spread at all widely, even within New
York. What should give cause for concern in the UK is the proportion of gay
men who become infected with HIV that is resistant to one or two classes of
anti-HIV drugs: almost one in four, according to a study published last summer.
These drug-resistant viruses are not causing Aids any quicker, but they can
seriously limit people’s treatment options.
It’s also important to be aware that HIV strains with resistance to
several classes of anti-HIV drug are becoming more common in the UK. Around
15 per cent of people with HIV probably have resistance to at least one drug
from each of the three main classes of anti-HIV drugs, and we don’t
know what proportion of those people are capable of transmitting that drug-resistant
virus to others.
Are people who are already HIV positive at risk of catching these
drug-resistant viruses?
We just don’t know. If it is happening, it’s hard to detect. We
know that `superinfections` do occur, but we don’t know how often drug-resistant
virus gets passed on. Experts suspect that the people who would be at the
highest risk of `superinfection` or reinfection with a news strain of HIV
would be those not on treatment and especially vulnerable to HIV infection
due to the presence of a sexually transmitted infection like a syphilis sore
or gonorrhoea.
• NAM provides information to help you think about your use of HIV
treatments, but this is not intended to replace discussion with your doctor.
Visit NAM at www.aidsmap.com
