Considerations for the clinical management of HIV elite controllers

Key take-home messages

• Fewer than one percent of people living with HIV are “elite controllers” (i.e. people who can spontaneously control HIV viral load without antiretroviral therapy).
• The ability of elite controllers to control their infection is likely due to genetics and a potent HIV-specific immunologic response.
• Elite controllers develop antibodies to HIV but have extremely low-level or undetectable viral loads, so there is a risk that their HIV infection may be misdiagnosed. However, there are no testing algorithms specific to elite controllers.
• While elite controllers are able to control their HIV infection, they continue to experience ongoing inflammation, decreases in CD4+ T cells, inflammation-associated cardiovascular disease and high rates of cancer, which suggest that their natural ability to control the virus over the long term may be coming at an immunologic and clinical cost.
• When managing elite controllers, clinicians should consider the potential benefits of antiretroviral therapy in reducing inflammation, maintaining CD4+ T cell levels and improving other health outcomes.

• Epidemiology and Determinants of Health
  • Epidemiology
• Population(s)
  • General HIV+ population
• Engagement and Care Cascade
  • Treatment