Eleven Percent Entirely Healthy Ten or More Years After HIV Seroconversion

A major San Francisco study of AIDS progression is finding that about 11 percent of persons infected with HIV are completely healthy ten or more years later; they not only have no HIV- related symptoms, but also have normal T-helper counts. A formal report on intensive studies of some of these patients is being prepared for publication. Meanwhile, a March 25 article in the San Francisco Examiner brought current findings to wider public attention. Researchers are trying to find out why the disease progresses very slowly (if at all) in some people; such knowledge might be useful in developing treatments.

The data is emerging from the Clinic Study, conducted by the San Francisco Department of Public Health (DPH) and the U. S. Centers for Disease Control. The Clinic Study began as research on sexually-transmitted hepatitis B, before AIDS was known; 6,705 gay or bisexual men who visited San Francisco's sexually- transmitted disease clinic from 1978 to 1980 were recruited, and frozen blood samples were saved. Later it was found that 489 of them were either HIV positive when they entered the study, or became positive at a known time between 1978 and the present. Because the approximate time of seroconversion is known, this cohort is providing some of the best information anywhere on how AIDS develops.

Of the 489 whose time of seroconversion is known, 341 were found to be HIV positive more than ten years ago, between 1977 and 1980. As reported last November1, 49 percent of these men had died of AIDS, ten percent currently had AIDS, 19 percent had ARC, 3 percent had lymphadenopathy but no other symptoms, and 19 percent had no clinical symptoms of AIDS or HIV. [Note: Survival is almost certainly better today; these percentages are for persons infected by 1980, years before antiretrovirals, pneumocystis prophylaxis, and other treatment improvements were in use.] Today more than half of that 19 percent -- 11 percent of the 341 -- not only have no symptoms, but also have normal T- helper counts.

We asked Susan Buchbinder, M. D., of the AIDS Office of DPH, whether the statistics on disease progression suggest that some of the 11 percent would never become ill, or if they were only the extreme end of the statistical distribution of slow disease progression. She said that no one knows at this time -- but that in either case, information about why HIV infection behaves differently in these people might help in developing treatments.

One of the major theories being studied now in conjunction with the San Francisco City Clinic is that certain blood cells, perhaps CD8 lymphocytes, secrete an unknown substance which helps to keep the virus in check. The group at the University of California San Francisco Medical Center, headed by virologist Jay Levy, M. D., has been investigating this possibility for several years. Other researchers, including Dr. Buchbinder and Alison Mawle, Ph.D., of the U. S. Centers for Disease Control, are investigating another kind of white blood cell, the cytotoxic lymphocyte.

Dr. Buchbinder asked us to let our readers know that any gay or bisexual men who visited San Francisco's STD clinic from 1978 to 1980, and have not already been in contact with the research team, could call to see if they have frozen blood stored. They must give permission for their blood to be used for research. Persons who participate in research can learn about their own health history and status, and also they will be contributing to knowledge which could help to improve HIV treatments. Those who may have blood stored can call Paul O'Malley at the Clinic Study, 415/554-9030.

References

1. Rutherford GW, Lifson AR, Hessol NA and others. Course of HIV-I infection in a cohort of homosexual and bisexual men: an 11 year follow up study. British Medical Journal November 24, 1990; volume 301, pages 1183-1188.