HIV elite controllers

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