HIV Puzzle Explored -
Patient Survives For 15 Years
NEW YORK (Reuters Health) - The enigma of HIV continues with a new report of an elderly patient who has survived with the infection for about 15 years, untroubled by any virus-related complications, according to a group of Italian physicians.
Writing in the Correspondence section of The New England Journal of Medicine for April 20th, Drs. Efisio Sulis, Paolo Lusso, and Licinio Contu describe their patient as a 78-year-old man who ``has never had any symptoms or signs of HIV infection'' even though he had been HIV-positive since 1985.
The researchers note that the man is heterosexual, never received a blood transfusion, and never injected intravenous drugs. They believe he was infected with HIV through sex with prostitutes.
The doctors ruled out the possibility of some sort of ''innate resistance'' to the effects of HIV by demonstrating that the patient's strain of virus was clearly able to infect cells exposed to it in the laboratory. Moreover, there were no genetic defects in the HIV strain that might have rendered the virus ineffective.
The patient's immune system also appears to be intact, with adequate levels of the cells needed to fight infection. Oddly, imaging studies of the chest did reveal ``a triangular-shaped mass suggestive of thymic tissue,'' according to the team.
The thymus, an organ found above and in front of the heart, is part of the immune system. It is normally at its largest in infancy and childhood, during which time it helps to mediate the immune response, eventually shrinking to a non-functioning state in adulthood.
Sulis, Lusso and Contu acknowledge that the situation ``is difficult to explain'' but speculate that the apparent presence of a thymus -- or thymic tissue -- in the patient, ``could explain why he has conserved immunologic responsiveness and has no symptoms of HIV infection.''
The doctors practice at the General Hospital Tommasini, Jerzu; San Raffaele Scientific Institute, Milan; and Cagliari University, respectively.
SOURCE: The New England Journal of Medicine 2000;342:1221.


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