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Mixed blessings for HIV couples
by Laura Lopez. Saturday Star, 17 May 2003. Republished courtesy of Independent Newspapers (Pty) Ltd.
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When a partner shows signs of HIV resistance in the face of a mate's positive status, it is at once a blessing and a burden. Known as discordant couples, thse pairings happen more often than one would think, according to doctors and HIV/AIDS counsellors. In the absence of conclusive findings, some medical professionals attribute the apparent HIV resistance of some partners to factors ranging from genetics to anatomy.
Such pairs comprise about 10% of those tested and counselled by the Perinatal HIV Research Unit at Chris Hani Baragwanath Hospital and the University of the Witwatersrand, according to Dr Eftyhia Vardase, a specialist clinical virologist and Director of the Unit's HIV/AIDS Vaccine Division.
Mercy Lebakeng, a clinical psychologist in Benoni specialising in family therapy, says discordant couples make up a significant proportion of her patients. In her experience, accusations of infidelity do drive some couples apart, but for others, blame and anger are secondary concerns. "There's more commitment than accusation," says Lebakeng, who notes that in her practice, the women are usually the infected partners. "It's amazing, the amount of commitment the men have to the relationship. Their attitude has been: 'This is one challenge among other challenges."
But some married couples Vardase sees do not fare as well. "It overwhelms them - it is the most important thing in their lives," she says. "They are constantly thinking, 'Is this a judgement, is this infidelity?'" Some couples may come to her after five years of unprotected sex and often it is only a matter of time before the other partner will become infected, she says.
HIV is transmitted when it attaches itself to co-receptors present in the body's CD4 or "helper T-cells", which usually work to stave off infections. But once the virus integrates itself into them, these cells actually begin replicating it. Studies have suggested a difference in co-receptors, particarly one known as CCR5, which may explain why some people never contract the virus.
"Some people possess certain receptors that make it difficult for the virus to enter the cell," says Professor Umesh Lalloo, head of the Department of Medicine at the University of KwaZulu-Natal's Nelson R Mandela School of Medicine. Africans rarely possess the co-receptors - which are genetically inherited - associated with HIV resistance, Vardase says. Those particular forms are mostly found among northern European populations. She says there is little physiological evidence to support the idea of HIV resistance or the idea that discordant couples could be explained by differing strains of HIV found worldwide. "HIV is equally infectious and transmittable in all parts of the world."
Other less substantial theories surrounding the couples deal with the body's immune system. "People like this are often found to have much better immune responses," says Lalloo's colleague, Jerry Coovadia, the Victor Daitz Professor of HIV/AIDS research at the Medical School's Centre for HIV/AIDS Networking. Coovadia, who says theories about receptors remain speculative, believes some people may not contract the virus because of strong immnunity that allows other cells to effectively attack and kill those infected with HIV.
Vardase agrees, saying the difference in these people may lie in genetic markers called human leukocyte antigens (HLAs). These proteins play a role in activating the body's immune system. For Vardase and others, these couples offer insights that may translate into life-saving discoveries. Work is being done among HIV-negative sex-workers, who by being exposed to low amounts of the virus daily, seem to become immune to it. Such research has now translated into Vardase's own work with HIV-positive mothers and their HIV-negative babies.
But despite the medical importance of discordant couples, medical and government officials shy away from discussing them, fearing that public perceptions about resistance may lead to increases in risky behaviour. "The reality is that these couples are pretty rare," Vardase says. "You're not guaranteed any protection."
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