The 'New York Case'

A great deal of publicity was given to the case of a man in New York who experienced rapid disease progression after infection with a strain of HIV resistant to three of the four classes of antiretroviral drugs. The man was diagnosed with HIV in December 2004, having previously received a negative test result in May 2003.

However, experts discussing the case at the Twelfth Conference on Retroviruses and Opportunistic Infections in Boston in early 2005 said that this isolated case report does not indicate that the HIV strain found in this patient is aggressive, since disease progression is determined by the complex interaction between the virus and the host's genetic make-up.^{1 2} In addition, the source patient for this man's HIV infection was identified and found not to have experienced rapid HIV disease progression despite extreme similarity between their viruses.³ This suggests that the host's immune response may be more important in determining the speed of progression than the virus's virulence.

Phenotypic analysis of the NYC man's virus revealed that it is fully susceptible to efavirenz and the fusion inhibitor T-20. While coverage of high-profile case studies such as this might suggest that infection with multidrug-resistant virus spells no treatment options, several studies suggest that this is not the case.