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The elite controller phenotype.

Nicolas Noel1, Olivier Lambotte

  • 1AP-HP, Hôpital Bicêtre, Service de Médecine Interne et Immunologie Clinique Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological, Bacterial Diseases (IMVA-HB/IDMIT/UMR1184), Le Kremlin Bicêtre, France.

Current Opinion in HIV and AIDS
|February 26, 2026
PubMed
Summary
This summary is machine-generated.

Elite controllers (ECs) with HIV show diverse immune responses, offering insights into durable remission. Understanding EC heterogeneity is key for developing effective HIV cure strategies and personalized treatment approaches.

Keywords:
HIV controllerselite controllersimmune activationlong-term non progressorsreservoir

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Area of Science:

  • Immunology
  • Virology
  • Infectious Diseases

Background:

  • Elite controllers (ECs) represent a unique population of individuals with HIV who spontaneously control viral replication without antiretroviral therapy.
  • Studying ECs is crucial for understanding mechanisms of HIV remission and advancing towards a functional cure.

Purpose of the Study:

  • To review emerging data on the heterogeneity of elite controller phenotypes.
  • To discuss the implications of EC characteristics for HIV cure strategies and antiretroviral treatment decisions.

Main Methods:

  • Review of recent scientific literature and longitudinal cohort studies on elite controllers.
  • Analysis of data on HIV reservoir size, immune responses (adaptive and innate), and clinical outcomes.

Main Results:

  • Elite controllers exhibit significant heterogeneity, including persistent, transient, and viremic controllers.
  • Advances include characterizing the HIV reservoir and the roles of immune responses in maintaining viral control.
  • Longitudinal data clarify the dynamics of viral control loss and the presence of non-AIDS-defining comorbidities.

Conclusions:

  • Elite controllers provide critical insights into durable HIV remission and inform cure-oriented research.
  • Stratifying EC phenotypes may identify individuals nearing spontaneous functional cure.
  • Antiretroviral therapy decisions for ECs require individualized assessment of virological, immunological, and clinical factors.