Citing legal powers granted him under state and city law, Dr. Thomas R. Frieden, the city’s health commissioner, has ordered 39 labs to give his department data on any multi-drug resistant HIV cases they have tested that match or are similar to the virus that infected one New York City gay man.
“It is necessary for your laboratory to provide information with regard to all laboratory HIV resistance and drug susceptibility tests performed on specimens derived from New York City providers and/or residents since June 1, 2004, and prospectively through June 30, 2005,” Frieden wrote in a letter to labs that do such testing.
The gay man already identified with multi-drug resistant HIV may have been infected as recently as October of last year or as long ago as May of 2003 when he had his last negative HIV test. In either case, he rapidly progressed to AIDS. He received an AIDS diagnosis in January after being diagnosed as HIV-positive in December of last year. The man’s virus is resistant to many anti-HIV drugs though he currently appears to be responding to treatment.
In the letter, Frieden wrote that he was looking for cases that are identical or similar to the gay man’s virus. He requested data on cases that “match a specific nucleotide sequence” or that have resistance to anti-HIV drugs that is similar to the gay man’s virus.
While the data may help find anyone who might have been infected by the gay man it could also identify the man who infected him and anyone else infected by that first man. Published reports have said that the gay man is cooperating with the department and has identified some of his sex partners.
The request could also capture data on people who have HIV that is resistant to many AIDS drugs, but not the same drugs as the man already identified. The order was not restricted to information on just men or only adults.
Frieden wrote that the department wanted to “ascertain the distribution and extent of transmission of primary [multi-drug resistant] HIV” in the city and that the department “is conducting an epidemiologic investigation of a possible outbreak of three-class antiretroviral drug-resistant human immunodeficiency virus.”
This may be the first time that a health department has tried to use anti-HIV drug resistance information to define the scope of an outbreak or to find individuals who are part of that outbreak.
Frieden noted that federal law and the state’s HIV confidentiality law allow the department to gather such data.
“[T]he federal regulations specifically permit covered entities, such as your laboratory, to disclose individually identifiable health information without an individual’s consent when disclosure is required by law or to a public health department for authorized public health activities such as surveillance investigations,” he wrote.
Under state law, labs and doctors are required to report new HIV infections, AIDS diagnoses, viral load test results and T cell count test results to the health department. They are not required to report the results of drug resistance tests, but state and city laws empower Frieden to investigate disease outbreaks.
According to the letter, some labs have already responded, but, citing the ongoing investigation, the city health department declined to say if the effort had uncovered any matching cases or how many labs had submitted data. The health department press office gave Gay City News copies of the letter and the state and city laws that allowed the action.
Gay and AIDS groups saw the effort as part of a usual investigation into a disease outbreak.
“The commissioner of health does have the authority to request any data he needs to respond to an outbreak of disease,” said Jay Laudato, executive director of the Callen-Lorde Community Health Center, a gay health clinic in Chelsea. “This is probably the only reliable way to find these individuals, if they are out here.”
Assuming this turns out to be a virus that causes rapid progression to AIDS, finding people who are infected with it would aid those individuals because “they can get aggressive treatment to try and halt the progress of infection,” Laudato said.
The lab data may also answer the question, is this just one case or is it an outbreak of a new strain of virulent, drug-resistant HIV?
“The only way we will know if this case is not just a single case, but a new strain of HIV is for us to see it in other people,” Laudato said.
Responding by e-mail, Dennis deLeon, president of the Latino Commission on AIDS, wrote that the health department said it would be trying to find the gay man’s sex partner through traditional contact tracing but that the letter “is a much broader sweep.”
The commissioner “sees a genuine health threat and is acting on it,” deLeon wrote. “The only question is what is his office going to do when they find matches. What if the identified individuals refuse to cooperate with further examinations? What if the infected persons seek legal assistance? What are the limits of public health law in a case like this?”