A Healthy Dose of HIV

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.