The mechanisms by which a small percentage of HIV-1 infected individuals known as elite suppressors or controllers (ES) are able to control viral replication are not fully understood. Early cases of viremic control were attributed to infection with defective virus, but subsequent work has demonstrated that infection with a defective virus is not the exclusive cause of control. We isolated replication competent virus from the latent reservoir of elite suppressors and chronic progressors who have protective HLA alleles. No significant differences were seen in the replication capacity of these isolates. Furthermore, CTL escape mutations that have a negative impact on viral fitness were seen more frequently in isolates obtained from chronic progressors. Thus infection with defective or attenuated virus does not appear to be the cause of elite suppression. An increased understanding of the viral factors associated with control is important to understand the interplay between viral replication and host control and has implications for the design of an effective therapeutic vaccine that can lead to a functional cure of HIV-1 infection.
(C) 2013 Lippincott Williams & Wilkins, Inc.