Autoimmune Deficiency Syndrome, commonly known by its abbreviation AIDS is caused by a virus known as Human Immunodeficiency Virus (HIV) and was first isolated and identified in the year 1983. Even though the disease as such is very recent compared to the other infectious agents we are aware of, this disease has managed to kill millions of people all over the world. Initially, the disease was known as GRID (Gay-Related Immunodeficiency Disease) because of its prevalence in the community (goes to show the prejudice at play but that’s a discussion for another time) and once the actual cause of the and its epidemiology was discovered, it was renamed.
The virus is one of the most dangerous ones out there because it has the ability to suppress the entire immune system which can make the individual more prone to even minor infections or conditions. Such conditions though harmless for healthy people can be life-threatening for individuals with HIV. Science has come a long way to protect people with HIV and now, we even have therapeutics such as Anti-Retroviral Therapeutics (ART) that have helped prevent transmission and even helped in the suppression of the virus in individuals affected by it. But when these people are weaned off the medication, the virus reactivates itself and begins replicating within their bodies.
But is there a possibility that maybe some of us just have the ability to fight the virus? The answer is yes.
These groups of people are known as “Elite controllers” and for the longest time scientists have been trying to find out exactly how they manage the clear the infection from their bodies. This subset of people has the HIV-1 subtype that allows them to maintain an undetectable viral load in their bloodstream even when they’re not undergoing ART. This is great news because people who are infected always tend to have a detectable amount of viral load in their bloodstream at any given point in time. So, how does this work?
Different rates of disease progression in HIV infected individuals
Progression depends on viral load and CD4 (immune cell) count
HAART – Highly Active Anti-retroviral Regimen
Source:Tiemessen & Martinson, 2012
What is the exact mechanism?
The secrets lie in their DNA and these HIV genes are found in the barren spaces in the nucleus of the cell and are known as ‘gene deserts’. So, basically what happens in this region is that the chromatin (the thread-like material that makes up the nucleus and its machinery) tends to ball itself up and block any form of genetic activity in that region. When the virus tries to attack such regions, it is practically useless because these regions are already inactive. It has also been noted that HIV genes generally stay away from sites of genetic activity in such individuals and that cannot be a coincidence. Their cells have nipped out viral DNA and left only inactive remains of the virus basically clearing off the infection in them, in a sense.
In an HIV-affected individual, we can see complete suppression of a type of immune cell known as CD4 that helps in fighting off infections. But in elite controllers, a higher amount of CD4 cell count was also found. This could indicate that there is something else at play in their cell machinery. Now, we’re not saying that in elite controllers, the possibility of HIV infection is completely impossible because exceptions have been found in the past. What happens is that when these inactive viral remains are present in the cell, they get replicated along with the cell when cell division takes place. This leads to pure clonal (similar) replication of the virus without them having to put effort into it. This can increase the viral load in the body know as proviral load.
So, is there a possibility for immune therapy?
While these aspects have been identified in a very small population of the already limited number of elite controllers in the population, only one person to date has shown that the infection was completely cleared off from their body. This does give hope for a rather ‘decontaminating cure’ from within the body and there is also the possibility that a prolonged attack from the immune system could also produce the same effect in people with the proviral DNA.
All in all, it can be said that maybe in the future if we figure out the exact mechanism, an even bigger population can be treated for an HIV infection but for unless you’re an elite controller whose genome can self-vaccinate themselves, your best bet is to rely on ART.
Gebara, N. Y., El Kamari, V., & Rizk, N. (2019). HIV-1 elite controllers: an immunovirological review and clinical perspectives. Journal of virus eradication, 5(3), 163.
Tiemessen, C. T., & Martinson, N. (2012). Elite controllers: understanding natural suppressive control of HIV-1 infection. Continuing Medical Education, 30(8), 282-285.
Cairns, G. (2020, August 28). Elite controllers may self-vaccinate against active HIV infection, gene study suggests. Retrieved from https://www.aidsmap.com/news/aug-2020/elite-controllers-may-self-vaccinate-against-active-hiv-infection-gene-study-suggests
Kingsland, G. (2020, September 3). Rare individuals can ‘block and lock’ HIV in their chromosomes. Retrieved from https://www.medicalnewstoday.com/articles/rare-individuals-can-block-and-lock-hiv-in-their-chromosomes#Remaining-questions