Human Immunodeficiency Virus (HIV) is a dreadful disease, most doctors agree. Given that most doctors across Maharashtra are wary of treating this incurable disease, a Mumbai based doctor now says he has come across a rare kind of HIV patients called the ‘elite controller’ or the HIV controller’.
The doctor is treating 50 such patients without medication , probably the largest number of any population known to any HIV expert so far.
Supriya Shirodkar (name changed), a 39-year-old is a frequent visitor at his city clinic for routine follow-ups on her HIV status. She lost her husband to HIV, after which she too was declared as HIV positive. However, the doctor noticed that there was something very peculiar about Shirodkar’s illness.
While elite controller is a rare HIV infection, it is a point of research among scientists abroad. Dr Ishwar Gilada, the President of AIDS Society of India says he has personally seen about 50 such patients wherein their body’s mechanism does not allow the HIV virus to replicate even without starting HIV treatment.
“It was the fact that the virus wasn’t multiplying. However, she does have the HIV virus in her body. I have seen about 50 such patients, abroad it is a big matter of research. They are called ‘elite controller’ meaning the body does have a certain immune mechanism that controls these viruses from within the body,” said Dr Gilada.
The doctor believes that since they already have the internal mechanisms to fight such a virus and hence anti-retroviral medications aren’t necessary. “Shirodkar is not on any HIV medication because there is no need to have it unless the virus is spreading,” added Dr Gilada.
Doctors across the city say that they have also seen such patients, however no particular research has taken place in India and therefore, the treatment is still unknown. “I have seen very few people like this. Yet, it’s too early to declare them as a population. These are patients who have non-progressive or static counts of virus, the cause of which is unknown,” said Dr Vasant Nagvekar, Consultant Expert for infectious medicines at Lilavati Hospital, Bandra.
However, the rarity of the condition is still being questioned as no research so far has informed about the prevalence or treatment of this population, “I haven’t seen any such patient personally. But the immune mechanism, if used rightly can further help in developing better vaccinations,” said Dr Shrikala Acharya, Additional Project Director of Maharashtra State Aids Control Society (MSACS).
Speaking about its vaccination, the biggest debate regarding the elite controller population is about whether or not to keep them on their medication, “Even when you say that the virus isn’t multiplying inside them, they do spread the virus and that is why they should be treated with the usual HIV medications,” added Dr Nagvekar.
According to World Health Organization (WHO) report in 2013, individuals who naturally maintain low or undetectable HIV, RNA levels have low antibody responses. Elite controllers have a survival advantage and will accumulate in a population over time and may reach 5 per cent of people infected with HIV.
What makes HIV controllers different?
HIV controllers don’t exhibit the same signs of progression. The amount of the virus in their blood remains low, preventing the disease from worsening.
Possible traits that lend themselves to non-progression include:
- reduced levels of inflammation or swelling in the body
- more efficient immune responses to viruses
- an overall lack of susceptibility to CD4 cell harm
Some researchers believe that HIV controllers have immune system cells that are able to control HIV attacks. However, controllers don’t have any genetic mutations that would suggest they have better immune systems to fight the virus on their own. The exact reason and factors that go into non-progression is complex and not yet fully understood.
HIV controllers still have the disease despite their differences from other people with HIV. They’re also still able to transmit it to others. An HIV controller may expose others to the virus without even knowing it. Furthermore, CD4 counts are still depleted in controllers. They are, however, depleted at a slower rate than in other people with HIV.