Three-Drug-Class Resistant (3DCR) Rapidly Progressing
HIV
On February 11, 2005, the NYC Department of Health released
a health alert about an uncommon HIV infection that is
both resistant to many HIV medications and rapidly progressed
to AIDS. This “question and answer” fact sheet
provides the most current information available on this
case.
What is different about this case of HIV infection?
This case of HIV infection is different for two reasons:
1) the virus is resistant to 19 of the 20 available HIV
medications (anti-retrovirals), and 2) the person infected
progressed rapidly to AIDS.
What is “three-drug-class resistant (3DCR)
HIV”?
Three-drug-class resistant (3DCR) HIV is a virus that
has developed the ability to survive in the presence of
three of the four classes of anti-retroviral HIV medications
(resistance). Resistance to one or more drugs or classes
of drugs occurs in most persons who take anti-HIV medications;
that drug or drug class then stops working and the virus
multiplies. Such a person will need to change medications
in order to keep the HIV virus from multiplying.
Can multi-drug resistant HIV be passed from person
to person?
Yes. It is well documented that when one person transmits
HIV to another person, the virus remains the same. In
other words, it is resistant to the same medications in
both people.
What does “rapid progression to AIDS”
mean?
In general, when people are first infected with HIV they
experience flu-like symptoms that last from a few days
to a few weeks. During this time, the amount of virus
in their blood is very high, and their number of T cells
(the part of the immune system affected by HIV) falls,
although rarely to a level that is considered AIDS. (under
200). After this initial period, the immune system recovers
and fights the HIV virus on its own. During this time,
which can last up to ten years, they usually do not have
any symptoms. However, in some individuals, either because
of factors related to their own immune system or genetic
make-up or factors related to the virus itself, the initial
infection rapidly progresses to AIDS. These cases are
relatively rare.
Why did this person rapidly progress to AIDS?
This is the most important question and the answer is
still unclear. It appears that the rapid progression was
related to factors about the virus itself although researchers
are still trying to figure this out. This person’s
own immune system, genetic make-up, or crystal meth use
may have a played a role as well.
Is this a new strain of HIV?
Some people think this might be a new strain
because we have not seen the combination of multi-drug
resistance and rapid progression in HIV before. However,
this is still an HIV virus that is transmitted in the
same ways as every other HIV virus:through unprotected
sexual intercourse (vaginal and anal) and blood to blood
contact during needle sharing. Many more tests are needed
on this patient and the virus he is infected with to determine
if this is really a new strain.
What does all this mean to me?
First of all, it is important to remember that
HIV infection, regardless of the kind of virus, is preventable!
Use condoms, especially with anal sex! If you inject drugs,
do not share needles, or make sure to clean them properly.
Second, even if you are already HIV-positive, you can
still become re-infected with a much more serious form
of the virus and so HIV-positive people should use condoms
with each other!
Third, all drugs and alcohol will affect your judgment.
If you have sex while high on drugs and alcohol you are
at greater risk for HIV infection. Find ways of reducing
your risk by limiting your drug or alcohol use or not
having sex when you are high.
Fourth, crystal meth is a dangerous drug! While it enhances
the sex drive, it also impairs judgment and has been linked
to many new cases of sexually transmitted infections and
HIV. It is also highly addictive, and has destroyed many
people’s lives. We urge everyone not to use crystal
meth!
What should I do if I think I was recently exposed
to HIV through unsafe sex or needle sharing?
See an HIV-experienced medical provider right away for
an HIV test. If your exposure was within two days (48
hours), you should discuss taking medication that may
prevent you from becoming infected (post-exposure prophylaxis
or PEP). If you have recently had unprotected vaginal
or anal sex and have flu-like symptoms you should see
your medical provider for a specific test for acute HIV
infection.
At Callen-Lorde you can call and request a same-day appointment
in the Sexual Health Clinic or with any medical provider.
Call 212-271-7200 for an appointment.
If you have further questions we recommend that you call:
New York City Department of Health
1-800-TALK-HIV
GMHC Hotline
212-807-6655
1-800-AIDS-NYC (1-800-243-7692)
