New York might make multidrug resistance reporting mandatory.

The media frenzy that erupted over the announcement in February of a highly virulent and multidrug-resistant HIV strain has triggered a somewhat thorny debate on the future of HIV surveillance and prevention.

Scientists and activists criticized the New York City Department of Health and Mental Hygiene for prematurely inflating the significance of a single case of HIV. The department is once again inviting controversy by promoting a public health measure that some experts say is ineffective.

In a departure from current practice, city health commissioner Thomas Frieden is urging doctors and laboratories to provide data on multidrug resistance in newly diagnosed HIV patients. Officials are also debating whether to enforce a rule requiring labs to provide that information. The data would help “to both guide treatment and help us monitor the AIDS epidemic,” Frieden says.

Under New York state law, all laboratories must inform the city and state health departments of new HIV infections, AIDS diagnoses, viral load results and T-cell counts. Requiring reports of multidrug resistance would not need changes in legislation but would entail the creation of a new rule, which is under discussion, says Frieden. Officials are also discussing how best to tackle the technical details of reporting drug resistance. The recently erected citywide Commission on HIV/AIDS is also expected to release a report outlining strategies on HIV/AIDS prevention, treatment and control in a few months.

New York may become the first US state to require AIDS drug resistance data. The Minnesota Department of Health also in February e-mailed 300 infectious disease specialists asking them to consider resistance testing in newly diagnosed patients, but the request is by no means a mandate. Across the US, the so-called 'AIDS superbug' propelled public health officials to check locally for evidence of similar strains, and to reissue public health messages about HIV. But the US Centers for Disease Control and Prevention has no plans to implement federal public health measures until more information emerges about the lone New York case, says Karlie Stanton, a spokeswoman for the agency's HIV prevention office.

Some experts say although drug-resistant HIV strains may be on the rise, testing for resistance is not useful. The tests can help decide treatment regimens, but they are expensive, time consuming and do not always detect resistance in HIV patients who have lived with the virus a long time. “Until we have sufficient data to suggest that the prevalence [of drug-resistant strains] is five percent or higher in a population, it is a guess on the part of clinicians as to the utility of the test,” says Tracy Sides, an HIV epidemiologist at the Minnesota Department of Health.

Clinicians, epidemiologists, researchers and activists should together discuss what measures are most cost effective. , executive director of the . Julie Davids, Community HIV/AIDS Mobilization Project

With fewer federal dollars supporting AIDS work, the best use of the resources is to boost existing HIV prevention infrastructure rather than require resistance tests that may not be entirely effective, says Julie Davids, executive director of the Community HIV/AIDS Mobilization Project, a New York–based advocacy organization. “Clinicians, epidemiologists, researchers and activists should together discuss what measures are most cost effective,” she says.

Scientists in January detected the potent new HIV strain that progressed to full-blown AIDS within four months. HIV infections normally take about ten years to turn into AIDS.