One day in early 1995 a man named bob massie walked into my office at the outpatient clinic of Massachusetts General Hospital in Boston. Massie told me he had been infected with HIV—the virus that causes AIDS—for 16 years and yet had never shown any symptoms. My physical examination confirmed he was healthy, in stark contrast to all other patients I saw that day. At that time, a new combination of drugs was being tested that would eventually slow the progressive decline in immune function that HIV caused. In 1995, however, most people who had been infected with HIV for a decade or more had already progressed to AIDS—the stage marked by the inability to fight off other pathogens. The young man standing before me had never taken anti-HIV medication and strongly believed that if I learned the secret to his good fortune, the information could help others to survive what was then generally thought to be a uniformly fatal disease.

Massie was born with hemophilia, a blood-clotting disorder. In those days, nearly all hemophiliacs were HIV-positive because they were infused repeatedly with blood products agglomerated from thousands of donors—none of whom were screened for HIV until the mid- to late 1980s. (Today hemophiliacs receive artificial clotting factors, which pose no risk of HIV contamination.) Some of Massie's blood samples that had been stored for a study revealed that he had contracted HIV in 1978. Yet every test I conducted on him or his stored samples showed that the amount of virus in his blood was vanishingly small and that his immune responses seemed as strong as ever.

5 Comments

1. 1. vapur 09:39 AM 6/25/12

   Evolution in progress.
   
   I wonder, does this immunity get passed on to their children? What is the risk that new partners can get infected with these people who are undetectable? Is it possible that horizontal gene transfer triggered the initial immunity, or could trigger an immunity in those not genetically predisposed?

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2. 2. pinetree 11:30 AM 6/25/12

   Biologically this is to be expected. A species is as strong as its genetically ability to respond to future threats. This favors variations that prior to their need arising range between odd to even slightly harmful. Sexual reproduction allows those genes to spread (and you thought it was just for fun!).
   
   It is unlikely a naturally occurring biological entity like AIDS would evolve where nobody had any natural immunity. Mind you while it may be able to kill the vast majority of us, it should not be able to get all of us. Humanity is the result of freakish survivors of innumerable prior plagues and illnesses who just happened to have enough advantage over the rest of the population to get through alive and pass on the genes. While it is good to see this is true of AIDS, it is terrifying that artificially manipulated or created life forms may be possible which would/will defeat even natural immunity. For now, let's be thankful AIDS is not one of those and it is with in range of natural biological dynamics.

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3. 3. vapur in reply to pinetree 01:32 PM 6/25/12

   AIDS is not a biological entity, it's a symptom. I believe you have it mistaken for HIV. Even if you narrow the definition of AIDS to include HIV progression only, immune deficiency can still be acquired through other means (like chemotherapy, transplants, or old age). The two are correlated in the headline since people have been conditioned to believe they go hand in hand.

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4. 4. pinetree 02:06 PM 6/25/12

   Strictly speaking AIDS was the clinical observation of what has now been conclusively established as the impact on the host of infection by the the virus originally labeled HTLV-III and re-branded to the currently politically correct HIV. Of course other forms of immuno-compromise, some even induced intentionally after transplants, have long been known. Few of these, however, proved infectious. AIDS was a distinct phenomena that turned out to have a distinct causation.
   
   The article in the second sentence notes the oddity of HIV infection without displaying AIDS symptoms. It is common to equate the disease agent and the clinical condition such as polio and polio virus, flu and the flu virus, etc. Natural language does tend to conflate cause and effect especially when they are strongly correlated. It is true, however, that bullets don't kill people, and all that. I never found that distinction very convincing because people without bullets cannot do that kind of killing on their own. It is also true that if sloppy language were used it could be said that I have Yellow Fever because I was vaccinated with the attenuated virus to prevent to the potential of the more serious clinical manifestation later on. Perhaps in this case it is the separation of the usual cause and effect which stands out and the distinction could be made but I don't think it much alters the issues at hand especially when the potentially muddy references are pretty clear in context.

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5. 5. Mythusmage 10:00 PM 7/3/12

   It's hard to teach a man without legs how to walk. Think about it.

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