Persistent low-level viremia in HIV-1 elite controllers and relationship to immunologic parameters

Area of Science:

• Immunology
• Virology
• Infectious Diseases

Background:

• Human immunodeficiency virus type 1 (HIV-1) elite controllers naturally suppress viral replication.
• The precise level of viremia in elite controllers is not well understood.
• Quantifying HIV-1 RNA and correlating it with immune markers is crucial.

Purpose of the Study:

• To quantify plasma HIV-1 RNA levels in elite controllers.
• To investigate the correlation between viremia and specific immunologic parameters.
• To assess the long-term impact of low-level viremia on CD4(+) T cell counts.

Main Methods:

• Quantification of plasma HIV-1 RNA using a sensitive real-time reverse-transcriptase polymerase chain reaction assay (0.2 copies/mL).
• Assessment of HIV-1-specific immune responses, including neutralizing antibodies and Western blot reactivity.
• Longitudinal monitoring of CD4(+) T cell counts.

Main Results:

• Median plasma HIV-1 RNA was 2 copies/mL (IQR, 0.2-14 copies/mL) in 90 elite controllers.
• Viremia showed 2-5-fold fluctuations in most individuals; 6 maintained levels below 1 copy/mL.
• Viremia correlated with neutralizing antibodies and Western blot reactivity, but not CD8(+) T cell responses.

Conclusions:

• Low-level viremia is prevalent in most HIV-1 elite controllers.
• Higher HIV-1-specific antibody responses were associated with detectable viremia.
• CD4(+) T cell loss was more frequent in viremic elite controllers, indicating potential long-term harm.