High Immune Activation in Patients with Undetectable Viral Loads and Low CD4-Cell Counts

Experienced clinicians are all too familiar with the unfortunate HIV-infected patient whose CD4-cell count remains unchanged — or even declines — despite complete virologic suppression with antiretroviral therapy (ART). Occasionally, we also see surprisingly low CD4-cell counts among patients who control viral replication without ART (so-called “elite controllers”). In this cross-sectional study, researchers explored immune activation as a possible mechanism for this seemingly paradoxical response to HIV infection.

CD4-cell counts and T-cell activation levels were determined in four groups of patients: 30 HIV-infected elite controllers, 47 HIV-uninfected persons, 187 treated HIV-infected persons with undetectable viral loads (suppressors), a…