Controllers

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Term Definition
Antiretroviral Therapy SuppressorAn HIV-positive individual who registers undetectable HIV-RNA Viral Load (VL) levels while on antiretroviral therapy.
 
Elite ControllerAn HIV-positive individual who 1) has an HIV-RNA Viral Load too low to be detected (‘undetectable”) by standard assays -sometimes indefinitely, or 2) consistently registers an HIV- RNA Viral Load (VL) below 50 to 75 copies (<50 to <75 copies/mL), 3) remains healthy with minimal rates of decline of CD4+ T cells over time,* and 4) has never been on antiretroviral medications.

It is estimated that Elite Controllers make up well less than 1% of the infected global population (Hubert et al., 2000).

*Recent research has indicated that some Elite Controllers have subsequently ‘progressed’, as discussed in a paper entitled “Elite Controllers May Experience Higher Immune Activation Levels Than Other HIV-Infected Patients, Spurring Concerns of CD4+ Decline”, Hunt et al., 2007.

 
Elite SuppressorSee ‘Elite Controller’
 
HIV Controller“Epidemiologic factors associated with complete or near complete HIV Control in vivo ( ) have not been identified. Persons destined to become HIV Controllers appear to be less likely to have symptomatic primary infection than those destined to remain viremic (Madec et al., 2005a), suggesting that the complex virus and host interactions that lead to durable control of viral replication are already at play during the earliest phases of HIV disease (Altfield et al., 2006). The route of HIV acquisition is not associated with the likelihood of achieving an undetectable viral load in the absence of therapy (Madec et al., 2005b) and is likewise not a strong predictor of immunologic nonprogression (Prins and Veugelers, 1997). Gender is also not a limiting factor, with both male and female HIV Controllers defined, even though the average plasma HIV-RNA ‘set point’* is lower in women than men, independent of all other factors (Sterling et al., 1999). The potential impact of race, geographic location, and/or viral subtype on immunologic and virologic outcomes remains unknown, although controllers have been identified in multiple ethnicities and infected with different virus subtypes.”  [Entire paragraph excerpted from the abstract by Steven G. Deeks and Bruce D. Walker, “Human Immunodeficiency Virus Controllers: Mechanisms of Durable Virus Control in the Absence of Antiretroviral Therapy”, Immunity 27, September 2007, p. 407].

*’Set-point’ is a “level at which the concentration of virus in an individual’s bloodstream becomes stable. [This] ‘set-point’ can vary enormously among HIV-infected individuals. Some have only a few hundred particles of virus per milliliter of blood, others have hundreds of thousands. Those with the lowest levels are usually better able to control HIV”. [Excerpted from SF Gate article by Sabin Russell “Study Sees Hope for Controlling New HIV Cases: Genetic Advance is Spin-Off of Human Genome Project”, San Francisco Chronicle, July 20, 2007].
 
HIV Long-Term Non-ProgressorA small proportion (5% - 10%) of HIV-infected individuals who remain healthy over many years. See also ‘Long-Term Non-Progressor.’
 
Long-Term HIV SurvivorSee ‘Long-Term Non-Progressor.’
 
Long-Term Non-ProgressorAn HIV-positive individual who 1) has the ability to maintain normal CD4+ T cell counts for prolonged periods of time, greater than 10 years (>10 years);  2) may exhibit ‘undetectable’ HIV-RNA Viral Load (VL), but who typically exhibit low Viral Loads that are detectable.

The term “long-term non-progressor” applied to a ‘small proportion of infected individuals (5% - 15%) (who) remain(ed) clinically and/or immunologically stable for years’ (Cao et al., 1995; Munoz et al., 1995; Pantaleo et al., 1995; Sheppard et al., 1993) and “coined prior to the availability of Viral Load (VL) testing in the mid-1990’s". As viral load testing became more available, most long-term non-progressors were shown to have low to moderate amounts of virema (virus), and further follow-up revealed that many [LTNP’s] had progressively increasing viral loads and declining CD4+ T cell counts.”  (Goudsmit et al., 2002;  Lefrere et al., 1997;  O’Brien et al., 1996;  Rodes et al., 2004).   [Entire paragraph excerpted from the abstract by Steven G. Deeks and Bruce D. Walker, “Human Immunodeficiency Virus Controllers: Mechanisms of Durable Virus Control in the Absence of Antiretroviral Therapy”, Immunity 27, September 2007, p. 407].

  Per Dr. Stephen Migueles, Principal Investigator, LTNP Study, National Institutes of Health (November 10, 2008):

  An HIV-positive individual who 1) is clinically healthy, 2) negative history for opportunistic diseases, 3) stable T-cell counts, 4) set point HIV-1 RNA levels below the lower limit of detection (<50 - 75 copies/ml, depending on the assay), and 5) no ongoing antiretroviral therapy.

 

 
LTNPSee \'Long-Term Non-Progressor\'.
 
Natural HIV SuppressorHIV-positive individuals who ‘naturally’ suppress (control) the virus in ways not yet undefined.
 
Natural Viral ControllerSee ‘Natural HIV Suppressor’.
 
Non-ControllerAn HIV-positive individual who registers high levels of HIV-RNA Viral Load (VL) above 2000 copies/mL (>2000 copies/mL) and typically registers 10,000 to 100,000 copies/mL;  2) who exhibits the typical dramatic loss of CD4+ T cells. Note: May also be known as 'slow progressor' (SLP). This definition is a work in progress.
 
Non-ProgressorWith today’s more sensitive techniques for measuring viral levels in the bloodstream, HIV-positive individuals who area able to maintain low levels of HIV replication can be identified soon after their infection has been diagnosed.
 
Viral ControllerSee ‘HIV Controller’.
 
Viremic ControllerAn HIV-positive individual who 1) maintain HIV-RNA Viral Load (VL), greater than 75 copies/mL up to 2000 copies (<75 - <2000 copies/mL) over the course of their infection (as recent a two years);  2) maintains a normal range of CD4+ T cells (400 to 800); 3) has been off antiretroviral therapy for one year.
 


AIDSinfo HIV/AIDS Glossary

For additional information or for items not listed in the Zephyr Foundation's glossary, please see the AIDSinfo HIV/AIDS Glossary published by the National Institutes of Health at the U.S. Department of Health and Human Services. The AIDSinfo Glossary is a comprehensive resource designed to help health professionals, researchers, and people living with HIV/AIDS and their families and friends to understand the complex web of HIV/AIDS terminology.

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CROI 2011

  • Wednesday 9th March 2011
    This is our final bulletin from CROI 2011. We hope you have found our news coverage useful. You can find all our coverage at www.aidsmap.com/croi2011, including the news reports and bulletins.We are always looking for ways of improving and developing our resources – so if you have any comments that you would like
  • Thursday 3rd March 2011
    There is increasing evidence of the transmission of HIV strains with resistance to anti-HIV drugs in low- and middle-income countries. Research in eleven sub-Saharan African countries showed that the chances of detecting transmitted resistance increased by over a third each year that a country had been scaling up HIV treatment. A separate study involving people recently diagnosed
  • Wednesday 2nd March 2011
    A new type of anti-HIV drug that targets the first step in HIV’s entry into cells has done well in a Phase IIa study. Currently known as BMS-663068, the drug was shown to be safe and to work against the virus. HIV cell entry is a three-step process. The virus must first attach to the

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Controllers in Study

 Donation Thermometer
 Donation Thermometer
 Donation Thermometer
86%

Our Goal:
2000
Currently:
1725
Updated:
December 30, 2009

Current Breakdown: 505 Elite Controllers 1009 Viremic Controllers 211 Other