Sunday, February 13, 2005

HIV's Perfect Storm

Patient in New York has virulent AIDS from a resistant virus.
Feb. 13, 2005

No one is surprised. The question is how alarmed should we be? A man in his 40s has come down with the first recorded case of an HIV infection virtually resistant to the known medications, and much too quickly, a particularly virulent case of AIDS. Three of the four standard medications aren’t working and the infection moved from HIV to AIDS unusually rapidly—in this case months, not years. Mutations such as this are inevitable with pathogens but it isn’t clear how serious it is. Is it the harbinger of a deadly epidemic or just an isolated instance? The study has a n=1. Larry Altman and Marc Santora in the New York Times were careful to quote experts as saying the time to panic would be when a cluster of these cases show up; until then we’re dealing with an anecdote. Nonetheless, the story ran two days on the front page of the Times, including the iconic Sunday edition. One more thing: there are usually three ways to catch HIV, and two of them involve doing things you shouldn’t be doing. The patient, a homosexual in his 40s, was doing two of them: repeated, unprotected anal sex and drugs, in this case, crystal meth. That may limit appropriate panic to a much smaller universe. So far, it hasn’t.

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