The New York Case: Lessons Being Learned

Recently, a case of HIV infection in New York City gained wide public attention because of the possibility that it represented a novel and “superaggressive” virus, capable of causing rapid clinical disease and broadly resistant to available drugs (1). Publicizing this case before careful epidemiologic investigations were completed has been criticized as an overreaction that led to unnecessary public fear. The physicians and public health authorities involved argue that the unusual nature of this case—a transmitted drug-resistant virus and an apparently rapid disease course—required wide disclosure to find or prevent additional cases. At the recently concluded 12th Conference on Retroviruses and Opportunistic Infections, these vigorous debates prompted many press comments and a special 1-hour session to review the New York case and its implications. My purpose in this commentary is to place this case into the perspective of the broader experience with HIV infection and to explore the implications of how it was revealed to the public.

In the New York case, a middle-aged man who had been HIV negative in May 2003 was retested and found to be HIV positive in December 2004. Possible exposures included multiple instances of unprotected sex with men and abuse of methamphetamine. The patient described a 1-week illness with fever, pharyngitis, weakness, and fatigue about 6 weeks before his HIV diagnosis. However, at his first positive test result in mid-December, his HIV enzyme-linked immunosorbent assay showed full antibody reaction against viral antigens, which would be unusual for an acute HIV infection. Because the symptom complex of acute HIV is so nonspecific (and often absent), the timing of the patient's infection is uncertain. However, it could not have been much earlier than his previous HIV test in May 2003, which had yielded negative results. In mid-December 2004, the patient's CD4 cell count was 0.080 …