title: Prospective antiretroviral treatment of asymptomatic, HIV-1 infected controllers.
abstract: The study of HIV-infected "controllers" who are able to maintain low levels of plasma HIV RNA in the absence of antiretroviral therapy (ART) may provide insights for HIV cure and vaccine strategies. Despite maintaining very low levels of plasma viremia, controllers have elevated immune activation and accelerated atherosclerosis. However, the degree to which low-level replication contributes to these phenomena is not known. Sixteen asymptomatic controllers were prospectively treated with ART for 24 weeks. Controllers had a statistically significant decrease in ultrasensitive plasma and rectal HIV RNA levels with ART. Markers of T cell activation/dysfunction in blood and gut mucosa also decreased substantially with ART. Similar reductions were observed in the subset of "elite" controllers with pre-ART plasma HIV RNA levels below conventional assays (<40 copies/mL). These data confirm that HIV replication persists in controllers and contributes to a chronic inflammatory state. ART should be considered for these individuals (ClinicalTrials.gov NCT01025427).
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Hiroyu
authors.initials: H
authors.lastname: Hatano
authors.forename: Steven A
authors.initials: SA
authors.lastname: Yukl
authors.forename: April L
authors.initials: AL
authors.lastname: Ferre
authors.forename: Erin H
authors.initials: EH
authors.lastname: Graf
authors.forename: Ma
authors.initials: M
authors.lastname: Somsouk
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Sinclair
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel-Mohsen
authors.forename: Teri
authors.initials: T
authors.lastname: Liegler
authors.forename: Kara
authors.initials: K
authors.lastname: Harvill
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hoh
authors.forename: Sarah
authors.initials: S
authors.lastname: Palmer
authors.forename: Peter
authors.initials: P
authors.lastname: Bacchetti
authors.forename: Peter W
authors.initials: PW
authors.lastname: Hunt
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Martin
authors.forename: Joseph M
authors.initials: JM
authors.lastname: McCune
authors.forename: Russell P
authors.initials: RP
authors.lastname: Tracy
authors.forename: Michael P
authors.initials: MP
authors.lastname: Busch
authors.forename: Una
authors.initials: U
authors.lastname: O'Doherty
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Shacklett
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Wong
authors.forename: Steven G
authors.initials: SG
authors.lastname: Deeks
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D050197:Atherosclerosis / Q000097:blood / Q000188:drug therapy / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications / Q000188:drug therapy; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D008213:Lymphocyte Activation / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood*; D013601:T-Lymphocytes / Q000378:metabolism; D013997:Time Factors; D014779:Virus Replication / Q000187:drug effects*
chemical_list: D044966:Anti-Retroviral Agents; D015415:Biomarkers; D012367:RNA, Viral