HIV Elite Controllers — Can You Improve on Undetectable Viral Load?

Charles B. Hicks, MD

Retrospective data from the HIV Research Network suggests that elite controllers have significantly higher hospitalization rates than patients with virologic suppression on ART.

A small proportion of HIV-infected individuals maintain HIV RNA levels below detection by contemporary clinical assays without taking antiretroviral therapy (ART). These “elite controllers” (ECs) have delayed progression of clinical disease but show greater immune activation and inflammation than individuals with viral suppression on ART (medical control).

To investigate the clinical effect of EC status, researchers reviewed data on HIV-infected patients receiving care at any of 12 HIV Research Network clinical sites to compare hospitalization rates between ECs and patients with medically controlled infection. Of the 23,273 patients included in the analysis, 149 were ECs. These individuals were more likely than patients with medically controlled HIV to be female and black.

Between 2005 and 2011, 8456 hospitalizations occurred, with the all-cause hospitalization rate higher in the EC group than in the medically controlled group (23.3 vs. 10.5 per 100 person-years). Non–AIDS-defining infection was the most common cause of hospitalization in the medically controlled group, whereas cardiovascular disease was the most common cause in the EC population. In multivariate analysis, elite control (as opposed to medical control) was among the factors associated with hospitalization for any cause (adjusted incidence rate ratio [aIRR], 1.77; 95% confidence interval, 1.21–2.60), for cardiovascular disease (aIRR, 3.19; 95% CI, 1.50–6.79), and for psychiatric causes (aIRR, 3.98; 95% CI, 1.54–10.28).

Citation(s):

Crowell TA et al. Elite controllers are hospitalized more often than persons with medically controlled HIV. J Infect Dis 2014 Dec 15; [e-pub ahead of print].