SARS-CoV-2 infection disrupts the immune control status in a male HIV-1 elite controller

To report a case of an HIV elite controller (EC) who developed disease progression following SARS-CoV-2 infection, characterized by the breakdown of prior immune control.

We report a case of a Chinese male EC with HIV-1 CRF01_AE and protective HLA-B*57:01, who had sustained undetectable viral load and stable CD4⁺ T-cell counts for over 10 years. Following SARS-CoV-2 infection, he developed persistent HIV viral rebound (peaking at 4430 copies/ml) for eight months, accompanied by a profound CD4⁺ T-cell decline to 174 cells/µl, and subsequently initiated antiretroviral therapy. After treatment, viral load was effectively suppressed, and immune function gradually recovered.

This is the first reported case of an HIV EC losing immune control after SARS-CoV-2 infection, leading to prolonged viral rebound and severe CD4⁺ decline. Our observation demonstrates that elite control is conditional and can be disrupted by major immunological challenges, supporting enhanced surveillance of ECs during intercurrent infections.