title: Persistent low-level viremia in HIV-1 elite controllers and relationship to immunologic parameters.
abstract: 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.
authors: The Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Harvard, 149 13th St, Charlestown, MA 02129, USA. fpereyra@partners.org
authors: Florencia
authors: F
authors: Pereyra
authors: Sarah
authors: S
authors: Palmer
authors: Toshiyuki
authors: T
authors: Miura
authors: Brian L
authors: BL
authors: Block
authors: Ann
authors: A
authors: Wiegand
authors: Alissa C
authors: AC
authors: Rothchild
authors: Brett
authors: B
authors: Baker
authors: Rachel
authors: R
authors: Rosenberg
authors: Emily
authors: E
authors: Cutrell
authors: Michael S
authors: MS
authors: Seaman
authors: John M
authors: JM
authors: Coffin
authors: Bruce D
authors: BD
authors: Walker
mesh_terms: 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
chemical_list: D012367:RNA, Viral