HIV elite controllers
From IDWiki
Background
Definition
- Variably defined, but the common thread is that of someone who maintains an undetectable viral load despite not being on treatment
- One possible definition is someone with 3 or more undetectable viral loads over at least 12 months
Epidemiology
- Represents about 1% of people living with HIV
- Exact prevalence depends on the definition
- Many elite controllers will eventually have breakthrough
Pathophysiology
- Unclear; likely multifactorial
- Host genetics
- HLA type
- Heterozygous CCR5 deletion mutation
- Mannose-binding lectin alleles
- Tumour necrosis factor c2 microsatellite alleles
- Gc vitamin D-binding factor alleles
- Host immunity
- Effective cytotoxic T-cell responses
- Secretion of CD8 antiviral factor
- Secretion of chemokines that block HIV entry co-receptors (CCR5 and CXCR4)
- Maintenance of functional lymphoid tissue architecture
- Virus
- Attenuated strain of HIV
Management
- Unclear how much benefit they get from HIV treatment
