AIDS: Genetic Clues from HIV Elite Controllers Could Lead to Better Vaccines, Cancer Treatments (preview)

Feature Articles | Health See Inside

A rare group of HIV-positive individuals need no medicine to keep the virus in check. Their good fortune could point the way to more powerful treatments--and perhaps a vaccine

By Bruce D. Walker ?| June 25, 2012?|

UNIQUE STATUS: The genetic makeup of the individuals shown here has allowed them to fight the virus to a standstill without needing combination anti-HIV therapy. Scott Wafrock (top left) has lived with HIV for 26 years, Bob Massie (top right) for 34 years and Loreen Willenberg (bottom right) for 20 years. Doug Robinson (bottom left) learned he was HIV-positive in 2003.

Image: Richard Renaldi

In Brief

• One out of 300 people infected with HIV are naturally able to control the virus without having to take antiviral medications.
• Investigators believe the key to the good fortune of such elite controllers lies in the complex workings of their immune system.
• Genetic studies reveal the precise reasons why the targeting and destruction of HIV-infected cells occur more quickly in the body of an elite controller.
• Understanding this efficient, powerful immune response in greater detail might one day lead to better methods for preventing and treating AIDS.

One day in early 1995 a man named bob massie walked into my office at the outpatient clinic of Massachusetts General Hospital in Boston. Massie told me he had been infected with HIV?the virus that causes AIDS?for 16 years and yet had never shown any symptoms. My physical examination confirmed he was healthy, in stark contrast to all other patients I saw that day. At that time, a new combination of drugs was being tested that would eventually slow the progressive decline in immune function that HIV caused. In 1995, however, most people who had been infected with HIV for a decade or more had already progressed to AIDS?the stage marked by the inability to fight off other pathogens. The young man standing before me had never taken anti-HIV medication and strongly believed that if I learned the secret to his good fortune, the information could help others to survive what was then generally thought to be a uniformly fatal disease.

Massie was born with hemophilia, a blood-clotting disorder. In those days, nearly all hemophiliacs were HIV-positive because they were infused repeatedly with blood products agglomerated from thousands of donors?none of whom were screened for HIV until the mid- to late 1980s. (Today hemophiliacs receive artificial clotting factors, which pose no risk of HIV contamination.) Some of Massie's blood samples that had been stored for a study revealed that he had contracted HIV in 1978. Yet every test I conducted on him or his stored samples showed that the amount of virus in his blood was vanishingly small and that his immune responses seemed as strong as ever.

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