COLUMN ONE : Still Alive: Defying an Epidemic : Are some people immune to AIDS? That’s the hope of artist Rob Anderson and others who remain healthy years after acquiring HIV. The question also tantalizes researchers seeking a cure.

There is a wall of memorabilia in Rob Anderson’s art studio--faded family photographs, quirky postcards, esoteric quotes from Eastern philosophy. The wall reveals poignant details of the painter’s life. It also tells the story of what it means to be a gay man in San Francisco today.

Sprinkled amid this collection are pictures of the dead--a former boyfriend, elegantly dressed in black tie and carnation, a masseur who advertised “gifted hands,” the model who posed for some of Anderson’s most beautiful pencil sketches. These pictures, the legacy of AIDS, are hardly shocking here in the epicenter of the epidemic.

The shocker is that the artist’s own image is not among them--and may well never be.

On June 20, 1979, when San Francisco’s gay community was still swinging with sexual freedom and no one had heard of AIDS, let alone human immunodeficiency virus, Anderson went to a city health clinic and volunteered his blood for hepatitis research. That sample would eventually test positive for HIV.

Fourteen years later, the 40-year-old artist remains healthy.

His relationship with the virus that causes AIDS has been going on longer than the epidemic itself. While dozens of friends and hundreds of acquaintances have died, Anderson’s only complaints have been occasional colds or bouts with the flu. He has never taken AZT or other antiviral medicines. His CD4 count--the number of crucial immune cells that are the chief target of HIV--is above 800, well within normal.

“I think I’m going to live much, much longer than this, barring any great disasters,” he says calmly. “I don’t think AIDS is what’s going to kill me off. I’m going for old age.”

Many experts who once predicted HIV would kill everyone infected with it are beginning to believe Anderson may be correct. As the epidemic moves into its second decade, more researchers are turning their attention to a tiny group of “healthy positives”--people who for 10 years or longer have not only survived with HIV, but have never taken antivirals and whose immune systems appear to be able to keep the deadly virus in check.

Of course, it is impossible to predict how many healthy positives will remain healthy. Twelve years after AIDS made its appearance in the United States, the disease is still an unfolding story. Because HIV can incubate for 10 years or more without causing symptoms, only time will tell how well this subgroup will fare.

Nonetheless, scientists estimate that 10% of those infected will eventually fall into the healthy positive category, a figure extrapolated from three long-running studies of HIV-positive men. So far, these studies have documented 139 men who clearly fit the profile. Only eight have been infected longer than Anderson, making him one of the nation’s earliest documented cases of HIV. None has had the virus more than 15 years.

The blood of these healthy positives is becoming a hot commodity in medical laboratories, where researchers are working furiously to unravel the mystery of what seems to protect them from the ravages of HIV.

It is an unusual twist of science, looking for answers in the healthy rather than the sick. The hope is that the secret--or secrets--can be unlocked and then bottled, so to speak, in the form of a vaccine or drug that could create the same effect in others.

“They are a gold mine of information,” said Paul O’Malley, who directs the San Francisco study in which Anderson participates. “My feeling is that these guys are the closest thing we have to a cure right now.”

Although diet, exercise and a positive outlook may help, behavioral changes do not appear to be the link. Instead, researchers are pursuing intriguing clues that point toward certain key proteins that shift the balance of the immune system, genes that may enable cells to fight off infection with HIV or infection with a weaker strain of the virus--or a combination of the three.

Or is it, as some suggest, simply that these healthy positives are at the tail end of a very long bell curve, and they too will eventually succumb to HIV--albeit at a slower rate than most?

“That’s the big question,” said John Phair, an infectious disease specialist at Northwestern University who is studying this group, “and I don’t have the answer to it. We don’t have enough information to say that these people will not get some clinical problem due to their HIV infection. Whether they’ll die of it, I don’t know. We just need more time.”

*

Rob Anderson is not worried.

It is an unusually sweltering day in San Francisco, and the artist, in blue jeans and casual shirt, palette in hand, is behind his easel. His studio is a room off the kitchen in the faded Victorian he owns in the Potrero district, an eclectic neighborhood of warehouses, refurbished lofts and ramshackle houses. Just a few blocks away is San Francisco Bay--not the ritzy tourist bay, but the workingman’s bay of fish companies and shipyards.

The centerpiece of the studio is a huge oil painting in striking shades of orange and red and black. It depicts a man crouched inside a box, his body bathed in an amber shaft of light, his fingers digging tracks along its edge as he struggles to hang on. His arm and torso muscles ripple as he claws at the box; he seems to be slipping. Anderson calls this piece “Edge.”

In a sense, the painting is a self-portrait. But make no mistake, Anderson says. This canvas has nothing to do with HIV. Rather, it illustrates frustration--the frustration of a struggling painter who, after toiling in relative anonymity for years, yearns for recognition.

In fact, little of Anderson’s life seems to have much to do with HIV. Tall and lanky, with an easy smile and warm brown eyes, the painter pays scant attention to the virus that is hiding inside his body. He is not active in AIDS causes. When the other healthy positives in the San Francisco study decided to start a support group, Anderson did not feel any need to join.

He does not have survivor’s guilt. “There are people who mention that,” Anderson says with a shrug, “but I don’t feel that at all.”

He has had a steady companion for the past 10 years, a psychologist named Douglas Long who is uninfected. Long says Anderson “has kind of an innate optimism that helps him to believe he can remain healthy. He has also chosen not to make his HIV status a focal point of his life.”

He also eats right and exercises, taking long walks in his hilly neighborhood. He shuns caffeine, alcohol and processed sugar. He consumes vitamins and dandelion root on the recommendation of an acupressurist. A devotee of Eastern religion, he meditates twice a day. But this regimen, he says, has more to do with his lack of health insurance and concern about growing older than it does with any real fear he might develop AIDS.

Of course, there are times when fear does come, usually when he is feeling ill. Earlier this year, Anderson came down with the flu. He couldn’t help but wonder: Would this be it?

“You just sort of lie there and say, ‘This is really just the flu. I know that my T-cell count is 800.’ You have to do a lot of psyching yourself up, just reassuring yourself that you are not going to die of this. There’s been so much adverse news about it for such a long time. You have to keep telling yourself, ‘What they’re saying is one thing, but what’s going on with me is entirely different.’ ”

*

A short drive from the Potrero district, in an elegant, glass-domed marble and granite building a block from City Hall, Dr. Susan Buchbinder of the San Francisco Department of Public Health is trying to figure out just what is going on with Anderson and the rest of her healthy positive patients.

As the chief clinician at the department’s AIDS office, Buchbinder coordinates the medical research for the study in which Anderson participates. There are 42 healthy positives in her group, 8% of her total study population.

She has become convinced there is something special about these men. Within the past six months, she has begun collaborating with researchers at the National Cancer Institute, Massachusetts General Hospital, UC Berkeley and UC San Francisco to find out what it is.

Her study has an intriguing history.

It began in 1978 when a now-defunct city health clinic recruited homosexual men to donate blood for research on hepatitis B. That blood was later shipped to the U.S. Centers for Disease Control and Prevention in Atlanta, where it was frozen and stored. Little did anyone know how valuable it would prove to be.

In 1981, a mysterious illness began appearing in homosexual men. “Gay cancer” they called it, and of the 24 cases that occurred in San Francisco that year, 11 were in men who had been hepatitis study subjects.

O’Malley, the researcher in charge, was intrigued. With money from the CDC, he tracked down some of the original study participants and asked if their blood could be used for research. When the HIV antibody test became available in 1985, their specimens were tested.

Of those drawn in 1978, 4% were positive. By 1979, it was 12%, including the sample Anderson gave. By 1980, as many as 25% of the samples drawn for the ongoing hepatitis research showed presence of the AIDS virus, and of the specimens drawn in 1984, the figure was a whopping 66%.

The San Francisco researchers found themselves in a unique position. Not only could they chart the spread of HIV in their city, they could document cases that existed before the epidemic began. Their study, called the San Francisco City Clinic Cohort, is following 593 HIV-positive men. Buchbinder and O’Malley are also trying to track down others from the original hepatitis study, some of whom have left San Francisco.

No other group of patients provides scientists with such a long-range view of the course of AIDS. The nation’s two other long-running studies--the Multicenter AIDS Cohort Study (MACS), with 4,500 participants in Los Angeles, Baltimore, Chicago and Pittsburgh, Pa., and the San Francisco Men’s Health Study, with 1,000 subjects--began in 1983.

Together, these study groups have provided scientists with several important leads. The work that has garnered perhaps the most attention is that of Dr. Jay Levy, a virologist at UC San Francisco, who has shown that healthy positives have unusually high levels of certain white blood cells, called CD8 cells, which play an important role in the immune system.

Levy believes CD8 cells manufacture an undiscovered “cytokine”--a protein that acts as a chemical messenger to activate other cells--and that cytokine prevents the virus from multiplying. His task now is to identify the protein, which he calls “CD8 Antiviral Factor.”

“I am convinced that this mechanism is the way in which you will assure yourself of long-term survival,” Levy said, brushing aside criticism from skeptics who say they will believe it when they see it. “My greatest concern is that when we find it really works, people will say, ‘Oh, we should have had it sooner.’ ”

Levy’s work dovetails with that of two prominent researchers at the National Cancer Institute, Mario Clerici and Gene Shearer, who have been following another intriguing subgroup: people who have been repeatedly exposed to HIV but never infected. Some scientists see this group as simply the logical extension of the healthy positives; they theorize that those who resist infection completely may demonstrate the same, albeit stronger, immune response as those who become infected but stay healthy.

Clerici and Shearer’s work revolves around a type of immunity called cell-mediated immunity, in which CD8 cells play an important role. Rather than develop antibodies to attack HIV, it appears that in those people who evade infection killer immune cells engulf and destroy cells infected with HIV.

At the University of Texas Medical Branch in Galveston, Dr. Miles Cloyd has discovered that certain genes enable cells to resist infection with certain HIV strains. Cloyd theorizes that the healthy positives benefit from a lucky match of genetics and virus type.

“They go hand in hand,” he said. “You may have this gene for resistance to a particular strain and you’re unlucky and get infected with a different strain, and you get AIDS.”

In San Francisco, Buchbinder has found the healthy positives in her study are far more likely than others to carry a package of four genes that play an important role in helping the immune system fight off invaders. She says her statistical analyses show the chances of this being a coincidence are less than one in 10,000.

“People say: ‘Are these healthy long-term positives a unique group or is this just the end of the bell curve?’ ” Buchbinder said. “Finding these kinds of associations indicates that it is not just chance. There’s a reason these people aren’t progressing.”

But some are not so convinced.

Haynes W. Sheppard, chief immunologist for the San Francisco Men’s Health Study, says that among 300 study participants who have been HIV-positive for a decade, his group has identified 30, or 10%, whose CD4 cell counts are stable. But he notes that all the healthy positives show an initial loss of CD4 cells after infection, an indication that they are not entirely resistant to the virus.

“We talk about this group of people as though they were somehow very separated from everyone else,” Sheppard said. “In truth, what they are is the tail end of a curve.”

*

Rob Anderson thinks the scientists have got it backward.

The immune system, the strain of virus, genetics--all these things are probably important, he says. But more important than anything, he says, is attitude. And if he has a message for anybody in his position, that is it.

He has watched other HIV-positive people literally will themselves to die. “Maybe I’m kidding myself. Maybe it is some little gene somewhere that makes me continue living, but then I think of these friends of mine who worried themselves into the grave, and I think there’s got to be more to it than that. . . . I truly feel that everything is influenced by the mind.”

It was only recently that he told his friends and family that he is infected. Most people simply assumed he was not, and he preferred to let them think that. He couldn’t stand the thought that the people he loves would be afraid for him, but he finally got so tired of hearing and reading that HIV equaled death that he decided to let his secret out and prove the media wrong.

In the final analysis, he simply is not ready to die. There are, he says, too many paintings left to paint, too many drawings left to draw.

And, perhaps, a medical secret or two to unlock.