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Research into how some HIV-positive people keep the virus at bay promises to yield new treatment possibilities, from vaccines to gene therapies
Since the early 1990s, case studies had begun to emerge of patients who tested positive for HIV, but displayed no symptoms, and were later found to have extremely low levels of the virus in their bodies. The general consensus among the medical community was that these were freak incidents, and the patients were fortunate enough to have been infected with a faulty strain of HIV, which contained mutations preventing it from replicating itself.
Over the following decade Joel Blankson ran a series of experiments to test his idea that there might be something special about these people that enabled their immune system to suppress HIV.
He found it that the virus within them was perfectly fine. It was the patients that were special.More than 20 years on, we now know that a small proportion of HIV patients can naturally suppress the virus, and thus avoid developing symptoms, without requiring medication.
Scientists call these people elite controllers, and while they make up less than 0.5% of the 38 million HIV-infected people on the planet, they represent the forefront of research into the disease.
The concept of viral control exists for almost all infectious diseases, with asymptomatic Covid-19 patients being another example of elite controllers.
For most common viruses such as the Epstein-Barr virus, which is present in more than 90% of people around the world, the majority of people are controllers, and it is only a small proportion of vulnerable individuals who cannot suppress it. However, HIV is a particularly exceptional case. Unlike for Epstein-Barr, HIV controllers are the exceptions, not the rule.
The reason why HIV elite controllers are so interesting is that while antiretrovirals can help the other 99.5% of HIV patients suppress the virus, these drugs have to be taken for life, and are toxic to the body. It is common for patients to develop liver damage and even heart disease, and if they stop the therapy, reservoirs of HIV genomes hiding out in various cells and tissues spring to life again, flooding the bloodstream within weeks.
But understanding how elite controllers manage to keep HIV at bay may yield a wealth of new treatment possibilities. From vaccines that can boost the immune response in people newly infected with HIV, to gene therapies that can help put the virus into a permanent deep sleep, these approaches aim to share the secrets of elite controllers with the rest of the HIV-infected population.
Read the original article at https://www.theguardian.com/society/2021/apr/04/the-elite-controllers-who-can-naturally-suppress-hiv
