Important note: Information in this article was accurate in July 2000. The state of the art may have changed since the publication date.AIDSWEEKLY Plus; Monday, July 12 & 19, 1999
Daniel J. DeNoon, Senior Editor
CW HENDERSON PUBLISHER -- A dramatic HIV outbreak in rural New York state shows that nobody can safely ignore the AIDS pandemic.
It also suggests that HIV transmission may be spread rapidly by individuals who, for reasons that remain unclear, are extraordinarily infectious.
The outbreak apparently spread from a single, highly infectious man. Thirteen of 47 young women who had sex with the man became infected. The resulting AIDS scare led to the counseling and HIV testing of some 1400 people in rural Chautauqua county, New York. These tests identified other HIV infected individuals unrelated to the index case.
The high rate of infection transmitted by the index case - 31 percent - is a troubling suggestion that HIV can rapidly be spread by only a few individuals.
A report on the outbreak, and an accompanying editorial from the U.S. Centers for Disease Control and Prevention (CDC), appeared in the CDC publication Morbidity and Mortality Weekly Report ("Cluster of HIV Positive Young Women - New York, 1997-8," MMWR, May 28, 1999;48(20):413-6.
"The high rate of HIV infection among sexual contacts of the putative index case-patient over a period of many months raises the possibility that efficient transmitters of HIV exist and may contribute disproportionately to HIV transmission," the CDC editorial suggested. It had previously been thought that a person is most likely to transmit HIV either during acute infection, before the immune system has fully responded to the virus, or late in infection when the immune system has been destroyed. But the index case in the New York outbreak clearly had moved beyond primary infection and had not yet developed late-stage disease.
Neither sexually transmitted diseases nor intravenous drug use was associated with HIV transmission in this cluster of cases.
Although the index case refused to donate blood for analysis, 10 of his 13 HIV infected primary contacts did provide samples. Analysis of virus isolates showed that all 10 women were infected with highly similar viruses. These viruses differed from other viruses isolated from epidemiologically unrelated isolates from the same area.
The 13 women who apparently acquired HIV infection from the index case had sex with 84 secondary contacts. Although one of these individuals was found to be infected with HIV, the strain did not appear to be related to that acquired from the index case.
"Unrecognized social and sexual networks of youth at high risk for HIV and other STDs exist even in rural areas where HIV prevalence is relatively low, and these networks can facilitate the rapid spread of HIV infection," the CDC warned. "It is important for public health programs to provide effective HIV prevention services to youth in rural areas."
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