title: Possible transmission of human immunodeficiency virus-1 infection from an elite controller to a patient who progressed to acquired immunodeficiency syndrome: a case report.
abstract: BACKGROUND
  Most individuals infected with human immunodeficiency virus-1, in the absence of antiretroviral therapy, exhibit persistent virus replication and declining CD4+ cell numbers, and progress to acquired immunodeficiency syndrome within 10 years of infection. Elite controllers are rare individuals with human immunodeficiency virus-1 infection who can maintain undetectable plasma virus levels and remain asymptomatic without antiretroviral therapy. It has been proposed that elite controllers benefit from being infected with attenuated human immunodeficiency virus-1 variants.
  
  
  METHODS
  A 31-year-old African woman presented with human immunodeficiency virus-1 infection during pregnancy and was diagnosed with acquired immunodeficiency syndrome. Subsequently, her husband, a 31-year-old African man, was tested and found to be seropositive for human immunodeficiency virus-1. His plasma human immunodeficiency virus-1 ribonucleic acid level was found to be below the limit of detection of the clinical assay.
  
  
  CONCLUSIONS
  This report provides evidence for the first described case of human immunodeficiency virus-1 infection possibly transmitted from an elite controller to a patient who progressed to acquired immunodeficiency syndrome. This observation strengthens the case against avirulence as a mechanism that protects elite controllers.
authors.affiliation: Department of Medicine, University of California San Francisco, 513 Parnassus Avenue, Box 1270, San Francisco, CA, 94143, USA. m.scott.killian@gmail.com.
authors.forename: Michael Scott
authors.initials: MS
authors.lastname: Killian
authors.forename: Girish N
authors.initials: GN
authors.lastname: Vyas
authors.forename: Rochak
authors.initials: R
authors.lastname: Mehta
authors.forename: Karen
authors.initials: K
authors.lastname: Young
authors.forename: Osman
authors.initials: O
authors.lastname: Ebrahim