The study of elite controllers: a pure academic exercise or a potential pathway to an HIV-1 vaccine?

摘要

In the vast majority of untreated HIV-1-positive patients, viral replication leads to CD4~+ T-cell depletion, immunodeficiency, and ultimately to death. However, in patients known as elite controllers, viral replication is controlled to a point where the viral loads are undetectable by standard clinical assays. This issue of Current Opinion in HIV and AIDS is dedicated to advances in the study of these remarkable patients. As Lambotte and Okulicz describe in their review, these patients differ from traditional long-term nonprogressors (LTNPs) in that the definition of elite controllers is based on an undetectable viral load rather than stable CD4~+ T-cell counts. The incidence of 'elite' control is much lower (approximately 1% in most cohorts) than the incidence of immunologic nonprogression. Importantly, some controllers progress immunologically and many nonprogressors have detectable levels of viremia. The mechanisms that contribute to these very different outcomes are likely to be different.