SAN FRANCISCO — Matt Traywick's personal life has been a treatise on how to contract AIDS.
A gay man, he'd been "very sexually active" in San Francisco in the late 1970s, he said, and tended toward unprotected encounters. Then he entered a long-term monogamous relationship, and after he lost both it and his job as a computer specialist, he sank into a life of hard revelry and so much intravenous methamphetamine use that he wound up homeless on the streets of the city's Tenderloin district.
"I always knew I would be HIV-positive," Traywick recalled. "I hit all the major risk factors. It seemed there was no way I would have been negative. When I tested positive, my doctor cried and I didn't. Walking home, I wondered if there was something psychologically broken in me because, for some reason, I wasn't worried."
Against all logic and expectation, his nonchalance has turned out to be justified.
Traywick was diagnosed 21 years ago and has been healthy ever since, despite never having taken anti-HIV medications. Antibody tests demonstrate conclusively that he harbors the virus. But his immune system has controlled it so effectively that repeated blood assays have never shown a detectable level of the invader, even though Traywick still occasionally uses speed and engages in unprotected sex.
A graying, rumpled man of 46 with darting eyes and nervous hands, Traywick said he has "spent a lot of time trying to figure out why I was a survivor. There's got to be a reason some people are chosen not to die."
In the argot of AIDS research, Traywick is an "elite controller." Elites are extremely rare, accounting for an estimated one-third of 1% of known HIV-positive people and numbering perhaps 2,000. They and so-called viremic controllers, healthy infected people whose immune systems keep the virus at very low, although detectable, levels in the blood without drugs, are of keen interest to AIDS researchers.
"I would say we still don't have the faintest idea why these people are doing as well as they are," said Harvard medical professor Bruce Walker, director of the Partners AIDS Research Center at Massachusetts General Hospital. "Achieving the state that these guys have reached in their bodies -- if we could do that through some intervention, we would solve the AIDS epidemic."
Being a long-term controller is not an unalloyed blessing, as Kai Brothers' journey illustrates.
Brothers, 43, a computer technician for Wells Fargo bank in San Francisco, got his first indication something was amiss in 1987. A frequent blood donor, he received a certified letter from his blood bank stating that someone had donated HIV-tainted blood and asking him to be tested.
Brothers couldn't bring himself to respond. As a gay man, he knew he was in a high-risk group. Eventually he had himself tested but couldn't face learning the results. It was 1989 before he had himself retested, confirming his suspicions.
"I deep-down knew," he said in a recent interview. "There was a heavy feeling but not a surprise or shock. There was fear: 'Am I getting sick? How long will it take before this time bomb went off?' "
Not knowing his future, he quit his job and cashed in his 401(k) account to travel in Europe. On his return, he learned his infection-fighting T-cells -- HIV's target -- had dipped slightly below the normal range, and his doctor wrote him a prescription for AZT, the first effective HIV drug but one with often dreadful side effects.
"I decided I was not going to get it filled," Brothers recalled. "Something instinctively told me not to. I decided to wait it out."
Wait he did, and although his T-cells occasionally dipped, he also declined to use the effective multi-drug HIV cocktail when it became available in 1996. A man of moderate habits, Brothers took to practicing safe sex -- although researchers think it unlikely that controllers can infect others, he has taken no chances -- and listening more closely to his body when it requested food or rest or exercise.
While the AIDS epidemic roared through San Francisco's gay community, killing his partner and several close friends, Brothers escaped unharmed.
"But it was a bittersweet feeling," he said. "It's hard to call yourself a survivor when you've been through so much devastation, so profoundly affected by loss and grief. Isolated was definitely something I felt at the end of the '90s. I used to go to support groups and hear what everybody else was dealing with, having AIDS and opportunistic infections. It was uncomfortable because a lot of them were upset or angry or frustrated. I couldn't identify with them, and I couldn't identify with those who were HIV-negative."
Such feelings of isolation are common among controllers, said Dr. Florencia Pereyra of the Partners AIDS Research Center. She established a small support group for controllers in Boston and found that "because they're not on medication and don't have high mortality rates, they feel apart from the rest of the HIV community."