Purpose of review: Recent studies have been published characterizing the epidemiology of elite controllers. The demographic features, clinical characteristics, and HIV disease outcomes of elite controllers are summarized.
Recent findings: Elite controllers are defined by the ability to spontaneously suppress plasma viremia. Despite differing definitions in the literature, studies have shown that elite control of HIV infection is established soon after seroconversion and occurs in less than 1% of HIV-infected individuals. Elite controllers are demographically heterogeneous with diverse racial backgrounds and modes of HIV transmission, though genetic studies demonstrate an overrepresentation of protective HLA alleles. Elite controllers typically have elevated CD4 cell counts, stable CD4 trajectories, and more favorable clinical outcomes compared with viremic patients. A proportion of elite controllers, however, may experience HIV disease progression with loss of virologic control, CD4 cell declines, and rarely AIDS-defining events.
Summary: Elite controllers are a subgroup of HIV-infected individuals characterized by the ability to spontaneously maintain virologic control. The mechanisms underlying elite control are aggressively being sought to guide vaccine development and novel therapeutic strategies. As elite control may be a temporary state, the ability to distinguish and further characterize elite controllers with long-term clinical success from those with HIV disease progression is of major importance.
aInfectious Disease Service, San Antonio Military Medical Center, San Antonio, Texas, USA
bINSERM, Unit U1012, USA
cAP-HP, Department of Internal Medicine and Infectious Diseases, Bicêtre Hospital, France
dUniversité Paris-Sud, Bicêtre, France
Correspondence to Olivier Lambotte, MD, PhD, Département de Médecine Interne et Maladies Infectieuses, CHU Bicêtre 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France Tel: +33 1 45 21 27 83; fax: +33 1 45 21 26 32; e-mail: email@example.com