New York's alert that a gay man had become ill with a possible super strain of HIV has left experts eager for clues that could show whether the strain poses a real or imagined threat to public health.
But while some fear a repeat of the grim, early days of the AIDS epidemic and others say the strain is probably nothing new, just about everyone agrees that the case has revealed an enemy at work.
That enemy is the waning of safe-sex practices that were credited with curbing the epidemic after it cut a deadly swath through the gay community in the 1980s and 1990s. Lost on no one is the fact that the New York man contracted the virus during a spate of unprotected sex with more than 100 partners in the past year.
Even in Baltimore, which is described as having a tamer bar and party scene than New York or Washington, some in the gay community say they are seeing similar behavior. Disturbingly familiar, they add, is the man's repeated use of methamphetamine, or "crystal meth," a drug that fuels the sex drive and loosens inhibitions.
The drug is gaining a foothold in Baltimore and, some gays say, is easily obtained through Internet contacts and widely used in the bars and bathhouses of New York and Washington, which are a short drive or train ride away.
"When you're on it, your problems are all solvable," said John Flannery, a graduate student who says he has attended sex parties in New York and Baltimore where the drug is used. Any discussion of condom use disappears once "crystal" is used.
"It's like cocaine in that it gives you this invincible sense of well-being," said Flannery, adding that "crystal's" six-hour high makes it far more appealing in those settings than drugs that produce a brief euphoria.
In December, the federal Centers for Disease Control and Prevention reported that the HIV epidemic was increasing among gay men after many years of decline. New infections in that risk group rose 11 percent from 2000 to 2003, a period in which the infection rate overall had remained stable.
Mark Taylor, coordinator of addictions services at the Chase Brexton clinic in Mount Vernon, said he has had several clients who are HIV-positive and hooked on methamphetamine.
"The popularity is growing by leaps and bounds," Taylor said.
Taylor said he has counseled a "crystal" user in his 30s who has been HIV-positive for 15 years. "The crystal makes him feel young and attractive and healthy. We're encouraging him to be careful."
The New York strain
The nature of the New York strain remains a matter of intense debate, and it could be weeks before scientists can say with certainty what it represents. Some details may emerge during a national retrovirus conference that begins tomorrow in Boston.
New York's health commissioner, Dr. Thomas R. Frieden, announced Feb. 11 that a man in his 40s had contracted a rare strain that was resistant to three of the four classes of anti-retroviral medications and progressed unusually fast - in just a few months - to full-blown AIDS.
It was the combination of the two traits that made the strain so worrisome. Though doctors have struggled to treat drug-resistant strains for years, rarely had they seen one cripple the immune system so rapidly.
"I have never seen anybody do this so fast," said Dr. Patrick McLeroth, Chase Brexton's director of AIDS clinical services. He said the virus typically lingers in the immune system for three to 20 years before causing acquired immune deficiency syndrome.
"If they identify more than one patient and they have the ability to transmit to other patients, then we're looking at an epidemic that puts us back in the 1980s when the virus was untreatable," he said.
Dr. David Ho, who heads the Aaron Diamond AIDS Research Center in New York, is leading an investigation to see whether the same strain is showing up in others. Of principal interest are a man who was apparently infected before having sex with the New York man and a San Diego man who is infected with a virus that appears genetically similar.
Some doctors who have fought the epidemic since its beginnings say they have yet to see any evidence that the single case in New York represents anything new and dangerous.
Dr. Robert C. Gallo, the co-discoverer of the AIDS virus who heads the University of Maryland's Institute of Human Virology, said he can understand why public health authorities want to promote vigilance. But Gallo said their announcement may prove premature if further tests reveal the strain to be less dangerous than advertised and if it doesn't spread.
"You've got to worry about crying `wolf,'" Gallo said.
Dr. John Bartlett, chief of infectious diseases at the Johns Hopkins School of Medicine, said that a small number of the estimated 40,000 people nationally who become infected each year will contract a virus that is highly resistant to treatment.
"We don't like to see that, but it's what we expect to see on rare occasions," Bartlett said.