Persistent low-level viremia in HIV-1 elite controllers and relationship to immunologic parameters.
BACKGROUND
Human 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.


METHODS
Plasma 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.


RESULTS
The 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).


CONCLUSIONS
Low-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.
Pereyra
Florencia
F
The Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Harvard, 149 13th St, Charlestown, MA 02129, USA. fpereyra@partners.org
Palmer
Sarah
S
Miura
Toshiyuki
T
Block
Brian L
BL
Wiegand
Ann
A
Rothchild
Alissa C
AC
Baker
Brett
B
Rosenberg
Rachel
R
Cutrell
Emily
E
Seaman
Michael S
MS
Coffin
John M
JM
Walker
Bruce D
BD
D018791:CD4 Lymphocyte Count; D015658:HIV Infections / Q000276:immunology* / Q000821:virology*; D015497:HIV-1 / Q000276:immunology*; D006801:Humans; D012367:RNA, Viral / Q000097:blood*; D014766:Viremia / Q000276:immunology* / Q000821:virology; D014779:Virus Replication
D012367:RNA, Viral