Coverage of 2006 International
Conference on AIDS

August 14–18, 2006, Toronto, Canada

 

Looking to the Elite

Paul Dalton, Treatment Advocate, Project Inform
August 17, 2006

A rare and fascinating group of people living with HIV are going to be the focus of much needed research. Bruce Walker, MD, a leading immunologist based in Boston, MA, and others announced plans for a study of people who, despite living with HIV for many years and not taking medicine, show no sign of HIV-associated disease. Walker estimates that they account for 1 in 300 people living with HIV.

The scientists will be studying two groups of people. One group, termed elite controllers, have evidence of HIV infection, yet maintain extremely low, often undetectable levels of HIV in their bodies despite taking no drugs to treat HIV. The second group, called viremic controllers, are people whose immune systems are able to keep HIV in check, with low, but detectable levels of HIV in their blood without using any anti-HIV drugs.

Walker and his colleagues plan to enroll about 2,000 people—1,000 from each group—over the next year. They report having signed up about 200 to date. They will do a variety of tests, focusing on their genetic testing—hoping to determine if the unusual ability to keep HIV at bay can be explained by genetic or other factors associated with the immune system.

Understanding this phenomenon could go a long way to both helping people already living with HIV and possibly help move toward the development of a vaccine to prevent HIV infection.

HIV is a chronic viral infection and a disease of the immune system. While many important medical and scientific advances have been made on the virus half of this equation, far too little has happened on the immune system half. There are currently over twenty drugs approved to treat HIV, and not a single approved immune-based therapy. This is even more vexing when one considers that the one important chronic viral infection that has any cure rate from modern medicine is Hepatitis C, and the treatments for HCV are immune modulators. It is hoped that for people living with HIV, an understanding of a biological basis for this immune control could lead to better treatments for HIV.

One of the central barriers to developing a vaccine to prevent HIV infection is the still incomplete understanding of just what factors translate to immunity from HIV. These factors are called the correlates of immunity. While these correlates are well understood for some diseases—hepatitis B for example—they are not well understood for HIV. Walker and others hope that this research will help them and other scientists better understand what factors can help the human immune system effectively control HIV. This could lay the foundation for one of the greatest dreams for all of us fighting this pandemic—a truly effective vaccine to prevent HIV.

This research is just beginning and it will be some time before anything will be learned from it. As a treatment activist, I look hopefully at this elite group, hoping that hidden in their cells is the key, or keys, to solving the riddle of HIV.