Persistent Low-Level Viremia in HIV-1 Elite Controllers and Relationship to Immunologic Parameters

• Published in: The Journal of infectious diseases 2009-09, Vol.200 (6), p.984-990
• Main Authors: Pereyra, Florencia, Palmer, Sarah, Miura, Toshiyuki, Block, Brian L., Wiegand, Ann, Rothchild, Alissa C., Baker, Brett, Rosenberg, Rachel, Cutrell, Emily, Seaman, Michael S., Coffin, John M., Walker, Bruce D.
• Format: Article
• Language: English
• Subjects: Antibodies; Biological and medical sciences; Blood plasma; CD4 Lymphocyte Count; Fundamental and applied biological sciences. Psychology; HIV; HIV 1; HIV Infections - immunology; HIV Infections - virology; HIV-1 - immunology; HIV/AIDS; Human immunodeficiency virus 1; Humans; Infectious diseases; Medical sciences; Medicin och hälsovetenskap; Microbiology; Miscellaneous; Neutralizing antibodies; RNA; RNA, Viral - blood; T lymphocytes; Viral load; Viremia; Viremia - immunology; Viremia - virology; Virology; Virus Replication; Viruses
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1086/605446

BackgroundHuman immunodeficiency virus type 1 (HIV-1) elite controllers are able to control virus replication to levels below the limits of detection by commercial assays, but the actual level of viremia in these individuals is not well defined. Here, we quantify plasma HIV-1 RNA in elite controllers and correlate this with specific immunologic parameters MethodsPlasma HIV-1 RNA levels were quantified in 90 elite controllers with use of a real time reverse-transcriptase polymerase chain reaction assay with a sensitivity of 0.2 copies/mL. HIV-1–specific immune responses and longitudinal CD4+ T cell counts were examined ResultsThe median plasma HIV-1 RNA level was 2 copies/mL (interquartile range, 0.2–14 copies/mL). A longitudinal analysis of 31 elite controllers demonstrated 2–5–fold fluctuations in viremia in the majority of individuals; 6 had persistent levels below 1 copy/mL. Viremia correlated directly with HIV-1–specific neutralizing antibodies and Western blot reactivity but not with CD8+ T cell responses. Absolute CD4+ T cell decrease was more common among individuals with detectable viremia (P=.04) ConclusionsLow-level viremia is present in the majority of elite controllers and is associated with higher HIV-1–specific antibody responses. Absolute CD4+ T cell loss is more common among viremic individuals, suggesting that even very low-level viremia has negative consequences over time