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Elite controllers may pay a high price for their low viral load
Gus Cairns, 2015-01-07 07:40:00
About one in 200 people with HIV maintains an undetectable viral load and high CD4 counts without having to take antiretroviral therapy (ART). These so-called ‘elite controllers’ have long been the targets of research into how their immune systems control HIV replication, and whether treatments such as therapeutic vaccines could induce the same state in other HIV-positive people, enabling them to stop taking ART.
A recent US study, however, has found that the health of elite controllers (ECs) is in some ways poorer than the health of other people with HIV with CD4 counts over 350 cells/mm3 – and even of some people with detectable viral loads.
Specifically, the study found that over the six-year study, ECs on average spent more than twice as many nights in hospital than people on ART, and about 50% more than people not on ART and with detectable viral loads. After adjusting for various differences between the EC and non-EC population, the study still found that ECs were 56% more likely to be admitted to hospital than people with undetectable viral loads on ART. While ECs had lower hospital admission rates for some conditions, these were outweighed by considerably higher admission rates for cardiovascular disease and for psychiatric conditions.
This study, which is the first study to look at clinical outcomes in an adequately large group of ECs, has two implications. Firstly, it raises the question of whether ECs should be put on ART – or on other medications – to address their specific raised health risks. Secondly, as mentioned above, ECs have been seen as a model for immune control of HIV without ART, but the study brings into question whether they are the right model to aim for in trying to achieve a ‘functional cure’ for HIV (one in which people still have HIV but can stay off therapy for prolonged periods).
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