A free access article in the journal Clinical Infectious
Diseases describes the case of an individual controlling HIV to below 50
copies/ml in the absence of treatment (classified as an “elite controller”) who
became superinfected with another virus. The researchers were able to document
the source of the superinfecting HIV strain and report that after a brief
increase in viral load to a maximum of 25,000 copies, the elite controller was
able to regain his unusual degree of control of viral replication and has since shown viral loads consistently
around 2,000 copies/ml over two years of follow-up. CD4 counts have remained in
the normal range throughout. In contrast, the individual’s previously
uninfected partner who was infected with the same virus showed high viral loads
and decreasing CD4 counts, as did the individual who was the source of both
infections. The researchers note that the elite controller possesses the HLA
B*57 allele, which has been consistently associated with immunological control
of HIV replication, and conclude that at least in some cases “host mechanisms
seem to be able to repeatedly control HIV-1 replication, halting disease progression.” However, it's perhaps worth noting that the implications of the somewhat higher viral load levels observed after superinfection for the individual's clinical course remain to be determined.
Clinical Infectious Diseases 2008;47:000–000
DOI: 10.1086/592978
BRIEF REPORT
Recovery of Viremic Control after Superinfection with
Pathogenic HIV Type 1 in a Long-Term Elite Controller of HIV Type 1 Infection
(free access to full text)
Andrea Rachinger,1 Marjon Navis,1 Sander van Assen,2 Paul H.
P. Groeneveld,3 and Hanneke Schuitemaker1
1Department of Experimental Immunology, Sanquin Research,
Landsteiner Laboratory, and Center for Infection and Immunity Amsterdam at the
Academic Medical Center of the University of Amsterdam, Amsterdam, 2Department
of Internal Medicine, Division of Infectious Diseases, University Medical
Center Groningen, Groningen, and 3Department of Internal Medicine, Isala
Clinics, Zwolle, The Netherlands
A human immunodeficiency virus type 1 (HIV-1)–infected elite
controller (defined as an untreated HIV-1–infected person with a plasma HIV-1
RNA level <50 copies/mL for at least 12 months) who experienced a viremic
episode after superinfection regained natural viremic control, although the
viral loads in the patient's 2 partners, infected with the same viral strain,
were continuously 30-fold higher. Thus, host mechanisms seem to be able to
repeatedly control HIV-1 replication, halting disease progression.
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