Growing Epidemics of HIV in Eastern Europe

Growing Epidemics of HIV in Eastern Europe

A second plenary talk in the morning was by Christopher Beyrer, Associate Professor of Epidemiology and International Health at the Johns Hopkins Bloomberg School of Public Health in Baltimore Maryland. Dr. Beyrer does research around the world and spoke of the growing epidemics of HIV, particularly in Eastern Europe. In this region of the world many new infections result from intravenous drug use. He further explained that many countries have failed to deal with the unique problems of intravenous drug users. For example, in the roll out of antiretroviral therapy to poor countries distribution has often not provided for those who use drugs. In addition, many areas do not promote risk reduction in this group, such as by distribution of clean needles, a method that has been proven in several studies to reduce HIV transmission among drug users.

Patient zero - HIV-1 Strain

There were several other presentations during the day that will be of interest to the community. Dr. Blick presented a paper called "Patient zero: The Connecticut source of the multi-drug resistant dual-tropic, rapidly progressing HIV-1 strain found in New York City." He first reminded the group of a unique case that was reported by a press release earlier this year from the New York Health Department. It was a crystal methamphetamine-using individual who appeared to have been infected for months to a few years that had acquired a virus resistant to most antiretroviral agents and was experiencing rapid disease progression. The primary provider for this patient was contacted by companies that performed the resistance testing stating that they identified an individual with a virus that appeared to be highly related to that of the patient. Dr. Blick described how the person identified by the company, along with this individual's stable HIV-infected partner admitted to sexual relations with the "NY patient" around the time of his new infection. Further studies demonstrated evidence that there was some exchange of viruses between the HIV-infected stable partners and that their viruses were very similar to that of the New York patient. Despite this, the persons that were presumed to be the source or the virus had been infected for many years and did not experience rapid disease progression, as seen in the NY case. While there are still many details that need to be sorted out from these cases, there are several important lessons to be learned. First, it illustrates that crystal methamphetamine-use continues to be an important driving force behind the HIV epidemic. Second, it emphasizes the importance of using barrier protection, including among HIV-infected partners, where in this case there was evidence of possible superinfection which could have adverse effects on the course of disease. Finally it shows that rapid progression is influenced by a multitude of factors, not just the virus. Further research related to patients like this may someday advance our understanding of why different people handle viruses differently.