Skip Navigation LinksHome > September 24, 2013 - Volume 27 - Issue 15 > Natural history of HIV-control since seroconversion
doi: 10.1097/01.aids.0000431945.72365.01
Epidemiology and Social

Natural history of HIV-control since seroconversion

Madec, Yoanna; Boufassa, Faroudyb,c; Porter, Kholoude; Prins, Mariaf; Sabin, Carolineg; Monforte, Antonella d’Arminioh; Amornkul, Paulii; Bartmeyer, Barbaraj; Sannes, Mettek; Venet, Alainl; Lambotte, Olivierl,m,n; Meyer, Laurenceb,c,d,n

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Objectives: HIV-controllers spontaneously maintain HIV viremia at an undetectable level. We aimed to describe the delay to control from seroconversion, the duration of control, and risk factors for losing control.

Methods: HIV-controllers were identified from a pooled dataset of 24 seroconverter cohorts from Europe, Australia, and Canada (CASCADE). HIV-controllers had at least five consecutive viral loads less than 400/500 copies/ml, while antiretroviral therapy naive, for at least 5 years after seroconversion. End of control was defined as two consecutive viral loads above 2000 copies/ml. Duration of control was described using Kaplan–Meier estimates; factors associated with duration of control were identified using a Cox model. CD4+ cell count evolution during control was described using a mixed model.

Results: Of 9896 eligible seroconverters, we identified 140 (1.4%) HIV-controllers, the largest database of HIV-controllers followed from seroconversion. For 64 with viral load measured within 24 months from seroconversion, median delay to control was 16.7 (interquartile range: 7.8–37.9) months. Probability of maintaining control 20 years after seroconversion was 0.74 [95% confidence interval (CI): 0.64–0.85]. Occurrence of blips followed by return to undetectability did not increase the risk of loss of control [hazard ratio: 0.81 (95% CI: 0.10–6.70)]. However, CD4+ cell loss during control was significantly accelerated in individuals with blips.

Conclusion: In most individuals, control occurred rapidly after seroconversion; however, more than 3 years were required to achieve control in 25% of HIV-controllers. Control may be sustained even when CD4+ cell levels are below 500 cells/μl, opening important new perspectives to understand the physiopathology underlying control.

© 2013 Lippincott Williams & Wilkins, Inc.


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