HIV Elite Controllers: Is It the Immune System?

A small proportion of HIV-infected patients can control viral replication without antiretroviral therapy (ART). Such patients are often divided into two groups: Typically, those who maintain undetectable viral loads (<50 copies/mL) are considered “elite controllers,” whereas those who maintain low but detectable viral loads (50–2000 copies/mL) are considered “viremic controllers.”

To understand the basis of HIV control, investigators performed an in-depth analysis of viral and immunologic characteristics among elite controllers, viremic controllers, and untreated progressors (those with viral loads >10,000 copies/mL). The main findings:

• CD4 cells from elite controllers were readily infectible with HIV in vitro. This finding argues against the…