'Healthy positives' pose a mystery to researchers People have HIV, but no symptoms

September 08, 1993|By Los Angeles Times DL SAN FRANCISCO

SAN FRANCISCO -- There is a wall of memorabilia in Rob Anderson's art studio -- faded family photographs, quirky postcards, esoteric quotes from Eastern philosophy. The wall reveals poignant details of the painter's life. It also tells the story of what it means to be a gay man in San Francisco today.

These pictures, the legacy of AIDS, are hardly shocking here in the epicenter of the epidemic. The shocker is that the artist's own image is not among them -- and may well never be.

On June 20, 1979, when San Francisco's gay community was still swinging with sexual freedom and no one had heard of AIDS, let alone human immunodeficiency virus, Mr. Anderson went to a city health clinic and volunteered his blood for hepatitis research. That sample would eventually test positive for HIV, the virus that causes AIDS.

Fourteen years later, the 40-year-old artist remains healthy.

While dozens of friends and hundreds of acquaintances have died, Mr. Anderson's only complaints are an occasional cold or bout with the flu. He has never taken AZT or other antiviral medicine. His CD4 count -- the number of crucial immune cells that are the chief target of HIV -- is above 800, well within normal.

As the epidemic moves into its second decade, more researchers are turning their attention to a tiny group of "healthy positives" -- people who for 10 years or longer not only have survived with HIV, but also have never taken antivirals and whose immune systems appear to be able to keep the deadly virus in check.

But because HIV can incubate for 10 years or more without causing symptoms, only time will tell how well these healthy positives will fare.

Scientists, however, estimate that 10 percent of those infected will eventually fall into the healthy positive category, a figure extrapolated from three long-running studies of HIV-positive /^ men. So far, these studies have documented 139 men who fit the profile. Only eight have been infected longer than Mr. Anderson. None has had the virus more than 15 years.

The blood of these healthy positives is becoming a hot commodity in medical laboratories.

"They are a gold mine of information," said Paul O'Malley, who directs the San Francisco study in which Mr. Anderson $l participates. "My feeling is that these guys are the closest thing we have to a cure right now."

Although diet, exercise and a positive outlook may help, behavioral changes do not appear to be the link. Instead, researchers are pursuing intriguing clues that point toward certain key proteins that shift the balance of the immune system, genes that may enable cells to fight off infection with HIV or infection with a weaker strain of the virus -- or a combination of the three.

Or is it, as some suggest, they too will eventually succumb to HIV -- albeit at a slower rate than most?

"That's the big question," said John Phair, an infectious disease specialist at Northwestern University who is studying this group, "and I don't have the answer to it. We don't have enough information to say that these people will not get some clinical problem due to their HIV infection. Whether they'll die of it, I don't know. We just need more time."

Dr. Susan Buchbinder of the San Francisco Department of Public Health is trying to figure out just what is going on with Mr. Anderson and the rest of her healthy-positive patients.

As the chief clinician at the department's AIDS Office, Dr. Buchbinder coordinates the medical research for the study in which Mr. Anderson participates. There are 42 healthy positives in her group, 8 percent of her total study population.

She has become convinced there is something special about these men. Within the past six months, she has begun collaborating with researchers at the National Cancer Institute, Massachusetts General Hospital, the University of California, Berkeley and the University of California, San Francisco to find out what it is.

Dr. Buchbinder has found the healthy positives in her study are far more likely than others to carry a package of four genes that play an important role in helping the immune system fight off invaders.

But some are not so convinced.

"We talk about this group of people as though they were somehow very separated from everyone else," says Haynes W. Sheppard, chief immunologist for the San Francisco Men's Health Study. "In truth, what they are is the tail end of a curve."

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