Lessons from People with Nonprogressive HIV Infection

Abstract

Infectious diseases can be extremely variable in their manifestations, but human immunodeficiency virus (HIV) infection is notorious for its protean manifestations. One of these, the absence of any apparent progression of disease over a decade or more, is particularly intriguing. The average time from HIV infection to death is 10 years, but clinical and immunologic decline is generally evident much earlier. About 5 percent of infected people are characterized as having nonprogressive infection because they remain healthy and do not have the declining CD4+ lymphocyte counts that are evident in people with progressive disease.1 Although we remain uncertain of their eventual fate, people with long-term nonprogressive infection nonetheless have especially favorable outcomes of an otherwise fatal disease. From these patients we may be able to learn important lessons that could improve the treatment of those with progressive disease. In this issue of the Journal there are three reports of investigations into the possibility that people with long-term nonprogressive infection represent some special circumstance of the virus–host interaction.