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HIV is a virulent infection, and it's difficult to treat too; a retrovirus, HIV resists all but a handful of drugs. But some people simply aren't affected by HIV. That could open the door to a vaccine — maybe even a cure.

For most people HIV is a simple, yes/no setup: if you're HIV positive, the only question is when you'll develop full-blown AIDS and the only way to stop it is through the use of antiretroviral drugs that are both highly expensive and come with many unwanted side effects. But for about one percent of people infected with HIV, there's another question. How do they do it?

For those people, dubbed "elite controllers," HIV isn't the life-threatening infection that it is for others. They don't expel the virus from their bodies altogether but they do go into remission, without drug therapy and sometimes for decades.

 

 

For elite controllers, HIV is more like herpes simplex, a background problem. 

 

Obviously, if HIV could be a background problem for everyone infected with it, that would be a massive step forward — especially in areas of the world where access to medical care is sparse and AIDS takes a terrible toll on families. So scientists have been studying "elite controllers" carefully since they first came to light, looking for a way to make their amazing ability transferable.

Elite controllers are usually found in adulthood, but there is a now-famous case of an unnamed French teenager who has apparently been an elite controller since birth. Her identiy has not been revealed, but her doctor, Dr Azier Saez-Cirion of the Pasteur Institute in Paris, says she has had only one major flare-up when HIV virus cells became detecable in her blood with standard tests. Otherwise doctors would assume she was uninfected if they didn't know she had been born infected and use special high-sensitivity tests to detect the low number of HIV cells in her body. 

This raises the question of how many elite controllers are flagged as uninfected because repeated standard tests don't reveal their low HIV blood counts.

HIV Immunity: The Story So Far

Previous efforts to transfer controllability from one subject to another have ended in failure, as have other attempts to confer immunity. After a brief period of excitement when a girl in a small experimental trial appeared to have been cured of HIV, an event which would have been the first of its kind, hopes were dashed when she turned out to still be infected with the virus. The girl, from Mississippi, was born infected and given large doses of powerful antitretrovials early in life, and appeared to be HIV free until the age of four, when it was discovered that she was still infected. 

Later, six people were given transplants from elite controllers in an effort to replicate the results of a man whose bone marrow transplant cured his lukemia — and his HIV. 

Known as "the Berlin Patient," US native Timothy Ray Brown was given a bone marrow transplant in 2007 from a donor who was an elite controller. Following the transplant, Brown's HIV went into remission and he appears still to be cured entirely of HIV. However, this isn't a method of curing HIV that can be successful worldwide because of the dificulty of finding donors and the huge expense of the operation. The results also don't seem to be repeatable: six other patients who had similar transplants, advised though not carried out by the surgeon who performed Brown's procedure, all died of AIDS. 

Late last year, doctors announced some success using a gene snipping technique called CRISPR. The technique removes a gene in human cells that codes for a protein on the outside of blood cells called CCR5. It's this protein that HIV uses to access the cell; without it, HIV can't attack the cell and enter it to replicate inside it. In lab experiments gene snipping resulted in about half the tested cells becoming "immune" to HIV attack. 

Continue reading after recommendations
  • "Some people can resist the ravages of HIV – here’s how," New Scientist, https://www.newscientist.com/article/dn27708-some-people-can-resist-the-ravages-of-hiv-heres-how/
  • "Girl Thought to Have Been Cured of HIV Has Relapsed," Mashable, http://mashable.com/2014/07/10/girl-thought-to-have-been-cured-of-hiv-has-relapsed/#lLjpyPB4cqqo
  • "It May Be Possible To Prevent HIV Even Without a Vaccine," Time Magazine, http://time.com/3561557/hiv-natural-immunity/
  • "Effort to cure HIV suffers major setback," Mashable, http://mashable.com/2014/12/18/hiv-aids-cure-setback/#XiJf8KsRckqI
  • Mind map by Steadyhealth.com
  • Photo courtesy of niaid:https://www.flickr.com/photos/niaid/6813396647/