Tuesday, October 20, 2009

The elite controllers of HIV

This is sort of off topic, but we found this fascinating story into the science of discovering a cure for AIDS.

Some people seem to live with HIV longer than others, and manage to avoid going into AIDS. Scientists are starting to study these groups of people, to see what it is within their bodies that can do what drugs do.

From the Wall Street Journal, reporter Amy Dockser Marcus tells us about the research.

Elite controllers are part of a larger group of "outliers," people who respond atypically to a disease, often by managing to stop it from progressing or by succumbing especially quickly. If researchers can figure out how elite controllers avoid developing AIDS, they might be able to replicate the defenses in other people through a vaccine or new drug.

Efforts to find people who control their disease are also under way in many other health problems such as hypertension, hemophilia, hepatitis C, Parkinson's disease and coronary heart disease. Studying them has yielded important insight into disease and new drugs.

But the breadth of the HIV controllers project, with more than 200 centers around the world examining data from the same group of patients, has yielded findings that may have important new implications: Small groups of people who already are elite controllers can be divided even further. No one is certain whether findings in just a handful of people might ultimately yield treatments helpful for more typical patients. But researchers who are identifying these tiny subgroups of controllers say the more homogenous a group becomes, the easier it is to see what is unique about them. "You want to take out as many variabilities as you can that exist among people," says Dr. Walker.

Studying a subset of controllers, Arthur Kim, an assistant professor of medicine at Harvard Medical School, helped make one of the most interesting discoveries. He had been following more than 700 patients with hepatitis C who came into Massachusetts General Hospital. Initially, he was trying to differentiate between two main groups -- the 20%-30% of patients who can fight off the infection, and the remainder, who remain chronically infected, which can lead to major complications such as liver failure.

Within the smaller group of patients able to clear the infection, Dr. Kim found a smaller subset: those able to control both a hepatitis C infection and HIV. He determined that in most instances people whose immune systems were exceedingly good at fighting off both of these viruses had the same genetic mutation.

Now Dr. Kim is using the HIV controllers study to find what he hopes will be 200 people able to clear hepatitis C and control HIV. He believes researchers could uncover new genes and mechanisms that help people fight off viral infections, including tuberculosis and malaria.

Looking at the healthiest of healthy outliers has led to a potential new approach to reducing cholesterol, says Helen H. Hobbs who, along with Jonathan Cohen at the University of Texas Southwestern Medical Center in Dallas, has been conducting a study aimed at identifying genes contributing to heart disease risk.

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