How elite controllers and posttreatment controllers inform our search for an HIV-1 cure

Abstract

A small percentage of people living with HIV-1 can control viral replication without antiretroviral therapy (ART). These patients are called elite controllers (ECs) if they are able to maintain viral suppression without initiating ART and posttreatment controllers (PTCs) if they control HIV replication after ART has been discontinued. Both types of controllers may serve as a model of a functional cure for HIV-1 but the mechanisms responsible for viral control have not been fully elucidated. In this review, we highlight key lessons that have been learned so far in the study of ECs and PTCs and their implications for HIV cure research.

Figure 1. Virologic and immunologic profiles of CPs, ECs, and PTCs.

ART is normally started in chronic progressors (CPs) during the chronic phase of infection, and a rebound in viremia is seen when therapy is discontinued. In contrast, elite controllers (ECs) are ART-naive subjects who control viral replication naturally. Posttreatment controllers (PTCs) are more often patients in whom ART is initiated during primary infection. These patients maintain control of viral replication when ART is discontinued. *Estimates depend on definition of EC and PTC. +, ++, and +++ indicate relative magnitude of each parameter.