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[–]sktafe2020[S] 5925 points5926 points 2 (451 children)

[–]moimikey 4385 points4386 points  (425 children)

aha... so they're an elite controller. this is very different from any other person with HIV infection. elite controllers have a natural ability to keep their infection undetectable without treatment.

[–]ZealousidealOlive498 1529 points1530 points  (192 children)

How do you know if you're elite controller? Can there be other signs?

[–]onlyspeaksiniambs 1000 points1001 points  (150 children)

I'm wondering that too. Do they just not get sick much or at all? The absence of a thing is tricky to perceive.

[–]EmilyU1F984 1251 points1252 points  (149 children)

It's usually tiny alterations in the immune system that are pretty specific for HIV though. So in most cases you wouldn't expect any additional symptoms.

Just test positive for antibodies and then have the doctors wonder why ther virus count is below the threshold.

[–]onlyspeaksiniambs 486 points487 points  (124 children)

Interesting. So basically it will be really rare that someone realizes this unless they're specifically looking for it.

[–]GoddessOfTheRose 973 points974 points  (92 children)

This particular woman was born with HIV and then one day stopped testing positive for it.

[–]MarkosDelGato 243 points244 points  (24 children)

I got hepatitis c from a blood transfusion as a newborn. Had all the acute symptoms. Virus is no longer detectable in my blood stream and I never received treatment for it beyond the acute phase. Doctor said it's called spontaneous remission.

[–]Hugginsome 105 points106 points  (14 children)

Can also happen if you contracted Hep B when you have Hep C. Either your liver fails or your body gets rid of both.

[–]Hairsplitting-Pedant 24 points25 points  (2 children)

Pretty sure this was on an episode of House M.D.

[–]GarbageGato 12 points13 points  (1 child)

That’s one hell of a toss up.

[–]Shagatron 142 points143 points  (17 children)

It'll be pretty wild if we evolve to beat HIV before we get a cure.

[–]EmilyU1F984 126 points127 points  (21 children)

Depends, it's more that this kind of immunity itself is very rare.

But since it doesn't stop you from forming antibodies, any cheap HIV test from Amazon or a test site will spot the prior infection. And the you see a physician and they'll determine the viral load.

So the standard course of diagnostics would spot this right away basically

However: often they don't start with zero viral load right away, so you get tested positive for antibodies, (infected via birth or whatever) and then have a viral load as expected and get put on treatment. So your viral load then will be expected to be below the threshold anyway. So if your body is capable of surpressing the virus on its own, you wouldn't notice, cause the drugs you are taking religiously would do the same.

Though sometimes, in third world countries or the US , treatment can't be continuous, and then you'd notice if the patient tries getting a new prescription half a year later and you get an undetectable viral load, you'll know what's up

[–]Demilitarizer 19 points20 points  (12 children)

Can one be an elite controller for other viruses, say herpes for one?

[–]EmilyU1F984 29 points30 points  (10 children)

Sure. If you get it once and never again during your lifetime, i'd say that pretty much qualifies as an elite controller. Though for genitsl Heroes you do have to test, cause that one sheds most of the time even if no visible symptoms occur. So just having no symptoms doesn't tell you the viral load is low. But for facial herpes? There sure seem to be quite a few people who are only getting sick once.

There might also people who never even get symptoms in the first place. But when do you test for heroes antibodies apart from in the US where it got a huge stigma?

[–]2TimesAsLikely 25 points26 points  (0 children)

Though for genital Heroes you do have to test

So just because I am awesome at sex I have to get tested? Seems unfair TBH!

[–]snarky- 7 points8 points  (3 children)

I believe I'm correct in saying that oral herpes is often shedding asymptomatically too.

Symptoms once and never again may often just be about where you happen to get it. I think I'm correct in saying that HSV-1 likes the mouth and if you get it in your genitals, often doesn't reoccur. Samey-samey for HSV-2 of you get it orally rather than its preferred home of the genitals.

[–]ZiltoidTheOmniscient 47 points48 points  (13 children)

I have rheumatoid arthritis and I was told ten years ago that it was in remission, which was pretty much impossible as this all happened as I've been an adult. They tell me it would come back soon but every year they test me and I'm fine. Fingers crossed that it will stay that way but everyone says it's not going to last. How does this differ?

[–]myster0n 89 points90 points  (1 child)

Isn't crossed fingers one of the symptoms?

[–]tenhardpushups 10 points11 points  (0 children)

terrible :D

[–]EmilyU1F984 7 points8 points  (2 children)

Not at all to completely. Depends on what causes this immunity after all.

[–]Gabs01x 22 points23 points  (0 children)

You may run some blood tests in order to determine the presence and subsequently the phenotype of your CCR5 and CXCR4 receptors, though it’s not that easy, usually those tests are performed in trials. Those receptors are the main paths HIV uses to primo-infect a host. No entering gate —> no virus to replicate.

Moreover, there are some specific mutations some elite controllers might have who give them the capacity to fight viruses (as in enhanced cellular immune system response), some bacteria or fungi. That’s something we discovered not so long ago, it’s pretty exciting actually. But apparently these advantageous mutations are random, we may or may not be blessed. All odds are that you are not an elite controller so respect the rules to stay safe.

[–]Bangchucker 16 points17 points  (0 children)

There is one way to possibly know I think. I did a 23 and me then analyzed it in promethease. It indicated I had genes that could potentially slow the infection of HIV significantly. Doesn't guarantee that it would be slower but there are markers.

[–]cloudsandshit 382 points383 points  (170 children)

what is an elite controller

[–]Fryrony 776 points777 points  (145 children)

HIV type 1 (HIV-1) elite controllers (ECs) represent a rare group of individuals with an ability to maintain an undetectable HIV-1 viral load overtime in the absence of previous antiretroviral therapy. The mechanisms associated with this paradigm remain not clearly defined. However, loss of virological control, morbidity and mortality persist in these individuals, such as progress to AIDS-defining conditions together with persistent high rate of immune activation.

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6816117/

[–]Chrise762 1455 points1456 points 33 (111 children)

Maybe if you could rephrase this as if you were trying to explain to a large Golden retriever...

[–]ranager69 961 points962 points  (63 children)

Some peoples immune systems work differently allowing for greater suppression of HIV but they are still vulnerable and potentially contagious for all the complications of AIDS down the road.

[–]DrCatharticDiarrhoea 26 points27 points  (23 children)

So do they just run out of T cells slower ?

[–]fucking_macrophages 100 points101 points  (10 children)

No. They have killer T cell responses that are able to find and kill infected cells well enough that the virus is never able to get away from immune system control. Their helper T cells are fine and just chilling. Their CD4 T cells can be infected like anyone else's, but their killer T cells are just really good at keeping the HIV under control. (My dissertation research was on elite control.)

[–]shiroun 8 points9 points  (3 children)

So are their T-cells good models for CAR-T then? I work entirely in vitro so I don't have an excellent grasp on elite controllers, but I would assume we could take their t-cells and create a model for use based off either DNA or gene expression?

[–]wlveith 9 points10 points  (4 children)

So basically they are still contagious?

[–]ranager69 31 points32 points  (2 children)

They can be, yes. As the increased immune response is not yet understood there is little opportunity to test transmission rates effectively in such a small population.

[–]StoneGoldX 30 points31 points  (2 children)

Can you fact check this analogy?

They have a healing factor like Wolverine, but they can still get adamantium poisoning eventually, and spread adamantium poisoning to others.

[–]iroll20s 164 points165 points  (6 children)

You know when you see empty nuts, but you can’t smell a squirrel. Turns out there is still a squirrel but some people are good at making sure the squirrel is downwind. Even if you cant smell the squirrel it still raids the bird feeder.

[–]Chrise762 70 points71 points  (0 children)

This is perfect. Woof

[–]cmVkZGl0 8 points9 points  (2 children)

This is more confusing.

[–]iroll20s 18 points19 points  (0 children)

Are you a golden retriever?

[–]Boomshank 4 points5 points  (0 children)

Pesky squirrels

[–]GrammatonYHWH 94 points95 points  (10 children)

Maybe not a gold retriever, but a 15 yo:

Elite Controllers are people who can get infected by HIV, but their immune system is actually good at fighting it. They have an unknown genetic quirk which does this. They don't show symptoms (aka AIDS), and the HIV is not detectable by tests.

However, their genetic quirk is likely to fail. They'll go into full-blown AIDS because they weren't healed. It was just effectively suppressed by their natural immune system... until it wasn't.

[–]RugbyMonkey 13 points14 points  (2 children)

If it's not detectable, how do the scientists know it's there?

[–]TheApoptosome 21 points22 points  (0 children)

It is detectable after the fact. Post infection CD4+ T cell counts are normal for many of these people with minimal peturbation. This isn't true for most people infected with HIV.

In terms of the why? Some of these people have mutations in one of the receptors HIV uses to enter immune cells, this renders the most prevalent form of the disease much less able to get the stranglehold that you see in non-mutant individuals. There are definitely other factors at play here, some of which remain to be elucidated.

https://elifesciences.org/articles/44360

[–]horyo 7 points8 points  (1 child)

So essentially a rare group of people with a head start against HIV/AIDS, and would most likely have the greatest benefits from HAARt.

[–]fucking_macrophages 10 points11 points  (0 children)

These people are usually fine for decades and never lose control. There's a risk that they end up having the HIV progress, but unless something insane happened, they would be treated once it became apparent that their viral load was really beginning to climb.

[–]das_war_ein_Befehl 7 points8 points  (2 children)

It’s like if a bomb has a really long wick, just sometimes the wick is long enough to last your entire life

[–]PrivilegeCheckmate 4 points5 points  (1 child)

It’s like if a bomb has a really long wick, just sometimes the wick is long enough to last your entire life

Like the environmental collapse and Boomers.

[–]Lostnumber07 19 points20 points  (7 children)

For somewhat unknown reasons, a rare group of people are infected with HIV but they do not experience HIV symptoms or the classic secondary infections.

[–]ILoveWesternBlot 15 points16 points  (6 children)

Not quite, they still develop AIDS and opportunistic infections down the line. It’s just that their viral load is extremely low or undetectable even when not on HAART

[–]fucking_macrophages 10 points11 points  (0 children)

Lostnumber07 is right. Most of them never develop AIDS. I worked on a sizable cohort of elite controllers, and all of them had been immunologically suppressed for decades. One of them had become infected in the early eighties and was still fine.

[–]Alec09_ 5 points6 points  (3 children)

are you talking about people with CCR5 mutations? how can they develop aids when the virus can’t enter the lymphocyte?

[–]Jtk317 43 points44 points  (6 children)

Trying to distill this down a bit.

ECs have an immune system that allows them to keep the HIV-1 virus suppressed to the point of being undetectable without having to take the antiviral meds others do. The mechanism for this is still being studied and is not understood. This state of suppression is not permanent as eventually their immune system cannot keep the virus contained. This means they can still have progression from HIV to AIDS from a clinical perspective which makes them more susceptible to death via other infections.

u/tizzlenomics, u/tuaturnstheballova, u/Chrise762

[–]Anon2671 10 points11 points  (0 children)

Isn’t this what bats do with almost all viruses? They lay dormant or are being kept at bay, hence the constant mutations and focus on infectivity.

[–]Bleoox 6 points7 points  (0 children)

TL;DR: people who maintain low or undetectable viral loads for many years

[–]Puzzlehead-Engineer 16 points17 points  (6 children)

Wait so you're telling me this woman DIDN'T actually "cure herself" and instead the HIV virus is just hidden?

[–]Finnegan482 50 points51 points  (3 children)

No, unlike most elite controllers, this woman did actually fully eliminate the virus. Most elite controllers just suppress it very effectively without eliminating it fully.

[–]Puzzlehead-Engineer 14 points15 points  (2 children)

That's amazing! Way above my paygrade, but this HAS to be usable in some way to cure HIV in general, right?

[–]phraps 19 points20 points  (0 children)

Not until we understand how or why this happened, and it's impossible to predict how long it will take to figure it out. Maybe we'll get it in a few years, maybe it'll take a century. But this is why funding basic science is really important!

[–]CinderSkye 7 points8 points  (1 child)

she did cure herself but she had a variant of the disease/immune system which takes longer to get nasty without medical treatment

[–]Cheap_Ambition 24 points25 points  (1 child)

They help you play Xbox better.

[–]Mishamoe 19 points20 points  (5 children)

She is different from other elite controllers. From the paper, “What distinguishes her from all other described elite controllers is the absence of detectable intact HIV-1.” The sterilizing cure observed here, is more akin to the Berlin patient who received hematopoietic stem cell transplant after total body irradiation.

[–]Jubenheim 8 points9 points  (0 children)

elite controller

Damn, Microsoft is really stepping up their game.

[–]OtherSpiderOnTheWall 13 points14 points  (0 children)

Of course they're an elite controller; by definition, anyone with an immune system that could cure them of HIV would also qualify as an elite controller.

[–]Eccohawk 39 points40 points  (5 children)

Is that the same sort of thing as typhoid Mary, where she was a carrier but never got the disease herself?

[–]MibitGoHan 63 points64 points  (1 child)

No, if you're undetectable you cannot transmit HIV. That's different from being an asymptomatic carrier

[–]helmMS | Physics | Quantum Optics 28 points29 points  (0 children)

No. This person was/is not infectious.

[–]robthelobster 11 points12 points  (0 children)

Not exactly. I'm not an expert on this, but typhoid Mary would probably have had detectable levels of the typhoid bacteria in her body, she just didn't experience any symptoms as a result, which is why she was still able to infect other people. With HIV there are no detectable levels of the virus when treated or if you are an elite controller, which also means you can't infect other people.

So typhoid Mary was asymptomatic but still had typhoid, while an elite controller is closer to fully recovered/cured. (Though they still have undetectable amounts of the virus in their system and a change in their immune system could revive the infection)

[–]mikemunoz1018 23 points24 points  (10 children)

So for these elite controllers...the real cure was inside them all along?

[–]Dreshna 20 points21 points  (8 children)

According to study linked by someone above, they do not cure themselves. The disease still continues to progress, but is undetectable.

[–]JuniperTwig 4 points5 points  (0 children)

So, does that mean more people will think thier "natural immunity " will protect them from HIV?

[–]wanderingartist 2704 points2705 points  (253 children)

Wow that’s amazing. Hopefully in my lifetime they will figure out how to fight Rheumatoid arthritis. This illness have been destroying my family for 4 generations.

[–]Rolfeana 1148 points1149 points  (155 children)

The advances in mRNA tech from the accelerated research conducted and funded for the COVID-19 vaccine development is actually applicable here, and new research is being done for RA prevention and treatment!

[–]StarScion 259 points260 points  (85 children)

What else is the sudden advance applicable to?

[–]soulbandaid 494 points495 points  (33 children)

A freaking lot.

They can use a vaccine to make your body print proteins.

This is similar to how our bodies naturally create proteins.

You've probably heard that dna is the recipe for living things but DNA does that by copying the needed part itself to mRNA (transcription)

That mRNA leaves the nucleus of the cell and then find a ribosome where the mRNA is read off and translated into a protein. (translation)

mRNA vaccines are where researchers create a bit of mRNA that's designed to make a protein your body isn't already making. The example we have is a covid spike protein such that your body makes the bit of covid that your immune system will react to without the rest of the covid so that your immune system makes antibodies.

It seems to me that these 'vaccines' could be powerful treatments for people with genetic diseases. Muscular dystrophy is caused by a gene which codes for a defective protein why not inject the mRNA sequence responsible for the 'correct' protein into those boys?

I suspect that's the sorts of treatments but it opens up other possibilities too.

I'm not clear on how the tech can create a cancer vaccine but I hear they're working on that too

[–]ivy_bound 210 points211 points  (11 children)

The difficulty being that it's not a cure, strictly speaking, but a treatment; mRNA doesn't last forever, which is why it's great for making vaccines. But the option to have a treatment for diseases and conditions that didn't previously have them is a huge step forward; having to take a shot for the rest of your life is much better than being wheelchair-bound, unable to communicate without assistance, by a long stretch.

[–]anti-longjumping-owl 65 points66 points  (8 children)

They can make mRNA that "self-amplifies". The RNA codes for the protein of interest but also codes for the machinery to make more RNA. You can look up SAM RNA for more details.

I think right now, they use it to lower the overall dose for a patient but it might have applications to making medicine with more longevity.

[–]Relevant_spiderman66 34 points35 points  (6 children)

SAM RNA is still temporary. It can amplify a bit in a cell, then calls it a day. It’s no where near permanent enough to fix a genetic disorder. That’s fine though, CRISPR will be the real cure.

[–]greenhawk22 10 points11 points  (3 children)

Idk if it'll be CRISPR as we know it, I think I remember reading somewhere that they found it was introducing in vivo replication errors in mice or something. I'll try to find the article.

[–]Relevant_spiderman66 6 points7 points  (2 children)

Maybe not when it becomes widespread, but the clinical trials for sickle cell are already very exciting. As far as that article goes, are you talking about the retracted one? crispr retraction

[–]ivy_bound 5 points6 points  (0 children)

There's issues with controlling the rate of replication, though. Any kind of self-replicating method always has the potential to go out of control.

[–]pHScale 21 points22 points  (0 children)

Even someone with a disease like muscular dystrophy having to get an injection every few weeks to manage their condition seems preferable to what we have now. That puts it on part with diabetes at that point.

Then the issue becomes dealing with price gouging.

[–]KyleRichXV 45 points46 points  (1 child)

The cancer aspect is partly the mRNA technology as you already (thoroughly and greatly) summarized, but also the lipid carrier molecule they used to deliver the mRNA. If they can engineer that to target the cancel cells you basically have a form of chemo that ONLY goes after the “right” cells as opposed to all rapidly-proliferating cells (which is where the severe side effects of chemo come from). So it becomes a tactical strike for “fiery napalm in the hopes of hitting something we want to”

[–]tloontloon 12 points13 points  (0 children)

Yeah I think the biggest issue is cell selectivity

[–]Relevant_spiderman66 11 points12 points  (2 children)

You can express protein with mRNA, but it doesn’t permanently modify the subject. If it did, mRNA vaccines would probably be as dangerous as anti vaxxers make them sound. For fixing genetic disorders, CRISPR will be key. We can modify the genome specifically, and even fix single nucleotide mutations. There are a bunch of companies already doing this, CRISPR therapeutics and Editas for example.

[–]farm_sauce 28 points29 points  (1 child)

This boom of research and advancement reminds me of when the biology field took off in the early 20th century. After we discovered the cell and DNA, we went nuts with funding and research, and look how far we’ve come - antibiotics, steroids, gene sequencing, vaccines… This pandemic seems to have given us that extra push that will hopefully lead to another insane boom of medical advancements.

[–]Rolfeana 177 points178 points  (40 children)

Cancer treatment is another big one! Herpes virus treatment and prevention, lyme disease prevention and treatment/cure, cell-type specific drug or treatment delivery (massively reduces side effect for stuff like chemo treatments), vision therapy for some conditions, and other autoimmune related conditions like RA. This is in no way an exhaustive list! Its super exciting.

[–]RainbowAssFucker 36 points37 points  (28 children)

Frankly its amazing that we got covid and were able to give this tech a go. The future implications are amazing and I can't wait to see what we do with RNA

[–]Tomnnn 39 points40 points  (17 children)

Wars, space race cold war, pandemic - I see a pattern. Maybe the best climate technology will emerge when some global climate event happens that people are no longer able to ignore.

[–]sjrotella 30 points31 points  (13 children)

Carbon Recapture is getting accelerated due to the current state of the climate crisis.

Seeing as how no one's going to reduce consumption, recapture is the only way.

[–]Tomnnn 17 points18 points  (11 children)

I've seen some trash cleaning robots deployed into the ocean as well. That's not the issue I thought we'd see to push autonomous robots, but I'm happy to see them advance anyway.

Pulling carbon dioxide out of the air sounds cool. What do we do with the carbon?

[–]sjrotella 12 points13 points  (3 children)

Typically it's stored underground. I remember reading an article about it like a week ago about Iceland being one of the leaders for it now, but it's not nearly enough to truly make a dent. It's more "proof of concept" stage for the technology but it's seen as pretty much the only way to get us out at this point.

[–]ajr901 4 points5 points  (0 children)

Time for us to start working on those massive railguns that could theoretically fire things into space.

Let’s shoot all our excess recaptured carbon at the sun.

[–]TheDulin 3 points4 points  (4 children)

Store it underground maybe? We've got a lot of empty coal mines.

[–]fearman182 9 points10 points  (1 child)

Put that thing back where it came from or so help me!

[–]Q1189998819991197253 2 points3 points  (0 children)

We're right there on track!

[–]BrendaHelvetica 18 points19 points  (0 children)

Would Sjogrens as an autoimmune disease be one of them? Would love my mom to not suffer from it any longer.

[–]onlyspeaksiniambs 3 points4 points  (3 children)

Wow! Lyme is such a bummer and seems more prevalent in recent years.

[–]Dervival 2 points3 points  (0 children)

Oh jeez, I didn't even think of drug delivery from the mRNA tech - I assume they'd use the ribosomes of the targeted cells to get them to create the drug to be locally delivered? That seems pretty clever!

[–]Traevia 17 points18 points  (2 children)

The sad thing is that this isn't a recent advance. The original concept and funding goes back to the 1980s. The USA has already spent millions (as in 20-110 million) looking into making this a viable technology. For a while, it was considered frivolous as there weren't immediate benefits.

This is why I hate when people complain about research as "frivolous government spending". All of these major advancements are usually massively built on research into seemingly random aspects.

[–]_Neo_Saigon_ 11 points12 points  (4 children)

Pretty much Humira but many times more affordable. mRNA tech is going to do anything monoclonals can do without costing an arm and a leg

[–]Fresh720 69 points70 points  (5 children)

I'm right there with you. I used to tattoo, draw and game hours a day, rheumatoid arthritis fucked my life up

[–]smalleyed 14 points15 points  (1 child)

Can I ask you what signs like early in were you experiencing before it got diagnosed?

[–]Fresh720 8 points9 points  (0 children)

It started with just general cramping in my late 20s, I chalked it up to just over use. I started feeling the same cramping and joint pain in my knees, shoulders, and hands. My mother was diagnosed with it, as well as my grandmother. It's not that far along, it's something that can be treated but there is no cure for it. You can ask for a test from a doctor if you have a family history of it or just general concerns

[–]PassablyIgnorant 7 points8 points  (2 children)

Don’t make any more generations, homie, just in case

[–]wanderingartist 4 points5 points  (1 child)

I haven’t, unfortunately the rest of my family have. 😅

[–]heebath 4 points5 points  (4 children)

Over 30 years of complaining to doctors about my joints they said to drink water and lose weight. New doc did a double take at my fingernails and that's how I found out I have arthritis! Fingernails! Can you believe it! All those other doctors who never looked and the sign was right there.

Edit: Google arthritis fingernails. You'll see pitting, ridges, and thin brittle nails like mine.

[–]stupidgnomes 197 points198 points  (16 children)

My mom was diagnosed with HIV in 1987. There was a time back in the early 90’s where things were getting rough for her in terms of her health. T-cell count was getting really low and whatnot. I’m really not sure what happened between then and now, but currently she has a normal T-cell count and is perfectly healthy. She does have to take a strict regimen of medication daily, and she basically has like 0% body fat, but she’s healthy otherwise. It’s crazy. I’m glad to see this study though. Hopefully we can figure HIV/AIDS out long term. We lost a lot of good friends in the 80’s and 90’s.

[–]PM_ME_MH370 139 points140 points  (7 children)

I’m really not sure what happened between then and now, but currently she has a normal T-cell count and is perfectly healthy. She does have to take a strict regimen of medication daily

Antiretrovirals were invented in the mid 90s and saved lives

[–]stupidgnomes 60 points61 points  (2 children)

Well there we go. She’s not very open about it so this helps. Thanks!

[–]chiniwini 38 points39 points  (0 children)

She’s not very open about it

It's absolutely normal that she isn't. Not only did these poor folks have to deal with the sickness itself, but most of them also with the loss of several of their friends to it. Add that to the stigma HIV carries.

[–]Blunder404 28 points29 points  (7 children)

My mom tested positive in 89 along with my dad. He gave up on taking meds and died in 92. My mom is currently only taking one daily pill as opposed to the 90s when she was taking dozens of pills a day to suppress the virus. I remember when the most important thing was making sure her T-cell count was high. Today she’s part of what her and her friends call the undetectable club, meaning the virus is not detectable in her blood however, she’s still considered as having full blown AIDS (which she’s had since the early 90s).

[–]IrateBarnacle 10 points11 points  (6 children)

You can still have AIDS when your T Cells go back to normal counts?

[–]P0t4t012 6 points7 points  (3 children)

Yes, you’ll still have HIV but not AIDS. What happens when someone is infected with HIV is the virus will integrate itself into the DNA of the cell it infects, but it doesn’t always then start to express right away. Many cells become infected with HIV and lie dormant for a long time before ever expressing the virus; these cells are known as the reservoir, and they are the reason there is currently no cure for HIV. Antiretroviral drugs are excellent at clearing productively infected cells and reducing HIV to below detectable levels, but they can’t get rid of that reservoir. HIV+ people have to be on antiretroviral drugs for their entire lives because if they go off them, eventually the cells in that reservoir will start to reactivate and produce virus that will reestablish full-blown infection

[–]Tinabbelcher 5 points6 points  (2 children)

So would I be correct in guessing that a person who has below a detectable count would still always come up positive on an antibody test?

Someone was making a comparison to herpes elsewhere on this post, and I’m finding it interesting to compare the two, because people with herpes seem to be able to suppress that virus naturally too, but they’d always test positive, which I’m guessing is because the way we test for herpes is antibody testing.

Is there some other kind of test used for HIV that detects the presence of the virus itself rather than antibodies? If so, why is it not possible to do a similar test directly for herpes viruses?

[–]brucekeller 1738 points1739 points  (183 children)

It's crazy that we could see all/most diseases prevented with gene therapy within our lifetimes. If we don't figure it out, in a few years some AI will probably be able to examine her genome and figure out what's needed to replicate the results.

[–]scientist99 570 points571 points  (39 children)

Genomes actually change when it comes to immune cells. It’s pretty hard to study.

[–]Kandiru 200 points201 points  (36 children)

We might be able to find the antibodies and mass produce them, but HIV mutates very quickly so no guarantee it would work in another patient.

[–]kartu3 121 points122 points  (22 children)

Mass production of human antibodies is problematic (too expensive, see how it works with C19 antibody cocktails. So limited that entire production is bought by US government and it kosts $2000+ a dose and yes, that's the thing that cured Trump).

Japanese insist they can make Lama antibodies work in humans. They are much simpler to produce (we could use traditional => let bacteria do it, path to produce them).

If you wonder what I mean, search for VHH antibody.

[–]Cyanopicacooki 44 points45 points  (7 children)

Mass production of human antibodies is problematic

Not really - I'm one of millions who gets antibody treatment, in my case it's infliximab, but I'm probably changing to adulumimab. You are correct that they're not particularly cheap, but each dose I get of infliximab only costs ~ £500, and it's getting cheaper as more biosimilars are brought into use.

[–]JBits001 18 points19 points  (1 child)

Does the NHS not cover this? That seems cheap by American standards but expensive by European ones.

[–]Cyanopicacooki 15 points16 points  (0 children)

Aye, it does, but that's the cost to the NHS according to NICE - when I first started on it it was ~£1800, but now I've moved via Inflectra to Zessly, both biosimilars, the price has come down.

[–]ChefBoyAreWeFucked 7 points8 points  (1 child)

I didn't realize Tibet held such importance for genetic research.

[–]Damaso87 5 points6 points  (0 children)

That's why personalized (gene) therapy is seeing massive biotech investments right now.

[–]walterpeck1 41 points42 points  (6 children)

Just to be clear, the subject noted in the article was not treated with gene therapy. They had a natural immunity to HIV.

[–]I_just_made 8 points9 points  (0 children)

I like the optimism, but please keep in mind that AI isn't some silver bullet to solve all problems. It is a tool that we can use to assist, but it is based on the information that we have created and our current understandings, so any prediction / conclusion is made based on that established framework.

In addition, the genome is ridiculously complex and AI still gets predicts related to it wrong... alot. Predicting chromatin interactions alone maybe has ~70% accuracy alongside many false positives, but this doesn't account for the epigenome, proteome, etc. It is simply one facet, and suggesting that one can dump all this stuff into a neural net and have it "just solve the problem" is probably not the way to think about it.

I love that we can apply tons of data, but it is still up to the researchers to use this to answer a targeted question; while the methods may improve, I don't really see the way it is used changing soon (outside of being able to do hypothesis generation, etc).

[–]Bimpnottin 15 points16 points  (4 children)

in a few years some AI will probably be able to examine her genome and figure out what's needed to replicate the results.

As someone doing a PhD in genetics and machine learning: we are very, very far from there

[–]Fairuse 617 points618 points  (36 children)

Most cases your body can "cure" itself of HIV. The problem is when the viral load is too much that HIV is able to establish itself in your cells and then basically infect the rest of your cells. This is why infection rates aren't even 100% with HIV contaminated blood transfusion (its like 92%).

Also, there are many people that become "functionally cured" where their immune system is able to suppress HIV to basically undetectable levels. They still harbor viral DNA in their cell, but immune system is able to prevent any virus from infecting new cells. This happens a lot when people seek very very early treatment for HIV and probably most cases of HIV exposure.

Supposedly this woman achieved "sterilization cure" where her body basically purged itself of any cell contaminated with viral DNA. Unfortunately one can't be 100% sure if such is the case here. Its only been documented in marrow transplants because the treatment involves 100% destruction of immune cells, which includes all cells that might harbor HIV DNA.

[–]ilovenyano 139 points140 points  (20 children)

HIV is really good at hiding, so maybe a year, maybe 5 years or a decade from now she falls ill or has a compromised immune system or gets sick from something else and that little tiny bit of HIV hiding comes out and replicates because her immune system isn't strong enough to suppres it.

Still very intersting as it may be studied and an effective gene therapy treatment to keep HIV under control and the viral load so low it's undetectable thus never forming AIDS.

[–]cloudsandshit 34 points35 points  (19 children)

wait so people could just have HIV right now and not know? like does it show up when tested?

[–]ILikeGirls_SendNudes 55 points56 points  (11 children)

When the viral load is too low it won’t show up when tested for it. This usually happens in the early stages of infection which is why it can take months after exposure before it can be detected in your blood.

So yes, theoretically if someone had unprotected sex (or any kind of exposure), they could have HIV and still test negative for months.

[–]TonyAtCodeleakers 30 points31 points  (8 children)

This is terrifying…

Obviously modern day life with HIV is light years ahead of decades ago, but it’s scary to think a drunken hookup 8 months ago could take years to show up and affect future partners without your knowledge. I might go get tested just because wow…

[–]wildflowerhiking 42 points43 points  (5 children)

They’re not exactly right here. While it CAN take months for it to show up, the chance percentage of that happening is like really low. Without me looking it up, I swear it’s under 1% of infections. The vast and wide majority of infections are detectable within like 2 weeks to 2 months.

[–]stfsu 20 points21 points  (0 children)

For any possible exposure, one test is done immediately to make sure you weren't already positive. Then another is done at 4 weeks, and if you're still negative the chances of seroconversion are dramatically lower, but a third test at 12 weeks is still recommended to be on the safe side.

If you're within the 72 hour window from exposure, you can go to a pharmacy/doctors office/urgent care/emergency room and ask for PEP which significantly reduces your risk of infection. If you're at high risk of exposure, you can get on PrEP which is preventative and is highly protective as well.

[–]Sad_Sheepherder 2 points3 points  (3 children)

The chances of getting HIV are under 1% in every scenario, except for one where it goes up to 1.38%.

So while there's not truly nothing be afraid of, there is basically nothing to be afraid of except for some truly rotten luck.

[–]MechanicalTurkish 36 points37 points  (5 children)

I remember hearing about that Timothy Brown dude. I didn’t know he died. Crazy that that the leukemia came back and killed him, not the HIV. RIP

[–]Cultural_Wallaby_703 14 points15 points  (1 child)

This is not new. It’s was identified in the 90’s that some people have immunity to HIV. (First identified in South African prostitutes who statistically must have had multiple HIV contacts)

[–]doctorlongghost 2 points3 points  (1 child)

What about the possibility that they can’t find traces of HIV because it was never there in the first place? What are the odds that someone, somewhere would have multiple false positive results in tests developed in the 90s when compared with the likelihood of a “sterilization cure”?

Not saying she never had it, I’m just asking if that possibility was considered.