Elite Controllers of HIV


Ayanna Nahmias, Editor-in-ChiefLast Modified: 11:40 AM EDT, 4 April 2010

Globally 33 million people have HIV, researchers suspect that 1 in 300 people are probably "elite controllers." One of the earliest known cases in the United States of an "elite controller" is a man named Rod Fichter who was first diagnosed in 1986 but has been living symptom free for over 20 years.

Both he and a friend tested positive, however his friend succumbed to complications from the disease shortly thereafter.  Much to Rod's surprise not only did he survive, he never developed any symptoms and remained healthy without ever taking medication. "It turns out that Fichter is among about 5 percent of all HIV-positive people who are 'controllers,' people whose bodies naturally keep the virus at extremely low or even undetectable levels."  Source: The Seattle Times, Warren King, 2006 Nov 23

"HIV-positive long-term nonprogressor individuals comprises about 1% of the total HIV population in the world; whereas the "elite controllers" may be much less. Why do some people deteriorate faster, while others remain symptomatically and immunologically normal for decades? There is a renewed interest in HIV-positive individuals who have survived since the period close to the earlier part of the HIV pandemic in the 1980s and have remained drug-naive.

Despite the varying disease progression rates, the majority of HIV-infected individuals eventually progress to AIDS.  There is a subset of HIV-positive individuals, who maintain high CD4+ and CD8+ T-cell counts, remain therapy naive and persistently infected with HIV-1 for more than 15 to 20 years.  In light of current observations, this subset can be divided into two groups.  One shows low detectable plasma viremia (< 5000 HIV-RNA copies/ml), termed long-term nonprogressors.

A second group shows plasma HIV-RNA values persistently below 50 copies/ml throughout the course of infection, and termed "elite" or "natural controllers".  The features common between both groups are the presence of high CD4+ and CD8+ T-cell counts,  strong immune responses, and low but variable cellular proviral DNA load."

Source: U.S. National Library of Medicine, National Institute of Health, AIDS Rev. 2007 Oct-Dec;9(4):195-207.

Lima is the capital and largest city of Peru. It is located in the valleys of the Chillón, Rímac and Lurín rivers, on a coast overlooking the Pacific Ocean. It forms a contiguous urban area with the seaport of Callao. Lima is the 5th–largest city in Latin America, behind São Paulo, Mexico City, Buenos Aires, and Rio de Janeiro. It is also the place where doctor's have identified a population of HIV+ who present the greatest hope for a developing a cure for the disease.

Today, a clinical research group comprised of doctors and scientists from MIT, Harvard, Massachusetts General Hospital, and the The Ragon Institute have identified over 600 Peruvians who have been HIV+ in some cases up to 30 years without taking medication or experiencing life threatening illnesses. Led by Dr. Bruce Walker, the team studies participants to learn why these individuals do not need to take medication and how their CD4 counts which is a measure of immune function remains stable despite the presence of the virus.

Researchers believe "elite controllers" may carry clues that could aid in the future development of a HIV vaccine. "According to Bruce Walker of the Ragon Institute in Boston, who is leading the Peru study, the development of a vaccine that could keep the virus level as low as these people keep it, could result in much less chance of infected individuals transmitting the virus to somebody else and much less chance of any kind of disease progression themselves. The goal, in studying these elite controllers, is to find out how it is that they're able [to] make HIV irrelevant to them, and are able to control it on their own, because [h]e believes that therein lies the solution to the HIV epidemic.

Peru is at the heart of this venture because of the geographic and racial diversity of its population which is critical the development of a treatment that could be used by individuals in Africa, Asia, Europe and the United States. At MIT Darrell J. Irvine has developed a program that show visually what happens when this very effective first attack when the virus is first introduced into the body. The critical cells are called Killer T-Cells, Irvine has figured out a way to recreate what really happens in the body and they begin to kill the virus immediately and then the T-Cell remains stationary after they have consumed and attacked the virus. They recently received a boost from the Bill and Melinda Gates Foundation. Doctor's hope that this research will provide the answer to questions about a cure for a disease that has eluded researchers for over 30 years." Source:  PBS NewsHour, Suarez, 2010 April 1.

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