Clinical outcomes of elite controllers, viremic controllers, and long-term nonprogressors in the US Department of Defense HIV natural history study

JF Okulicz, VC Marconi, ML Landrum… - The Journal of …, 2009 - academic.oup.com
JF Okulicz, VC Marconi, ML Landrum, S Wegner, A Weintrob, A Ganesan, B Hale…
The Journal of infectious diseases, 2009academic.oup.com
Durable control of human immunodeficiency virus (HIV) replication and lack of disease
progression in the absence of antiretroviral therapy were studied in a military cohort of 4586
subjects. We examined groups of elite controllers (ie, subjects with plasma HIV RNA levels
of< 50 copies/mL; prevalence, 0.55%[95% confidence interval {CI}, 0.35%–0.80%]), viremic
controllers (ie, subjects with plasma HIV RNA levels of 50–2000 copies/mL; prevalence,
3.34%[95% CI, 2.83%–3.91%]), and subjects with a lack of disease progression (ie, long …
Abstract
Durable control of human immunodeficiency virus (HIV) replication and lack of disease progression in the absence of antiretroviral therapy were studied in a military cohort of 4586 subjects. We examined groups of elite controllers (ie, subjects with plasma HIV RNA levels of <50 copies/mL; prevalence, 0.55% [95% confidence interval {CI}, 0.35%–0.80%]), viremic controllers (ie, subjects with plasma HIV RNA levels of 50–2000 copies/mL; prevalence, 3.34% [95% CI, 2.83%–3.91%]), and subjects with a lack of disease progression (ie, long-term nonprogressors [LTNPs]) through 7 years of follow-up (LTNP7s; prevalence, 3.32% [95% CI, 2.70%–4.01%]) or 10 years of follow-up (LTNP10s; prevalence, 2.04% [95% CI, 1.52%–2.68%]). For elite and viremic controllers, spontaneous virologic control was established early and was typically observed when the initial viral load measurement was obtained within 1 year of estimated seroconversion. Elite controllers had favorable time to development of AIDS (P=.048), a CD4 cell count of 350 cells/μL (P=.009), and more-stable CD4 cell trends, compared with viremic controllers. LTNPs defined by 10-year versus 7-year criteria had a longer survival time (P=.001), even after adjustment for differing periods of invulnerability (P=.042). Definitions of controllers and LTNPs describe distinct populations whose differing clinical outcomes improve with the stringency of criteria, underscoring the need for comparability between study populations
Oxford University Press