Clinical Outcomes of Elite Controllers, Viremic Controllers, and Long-Term Nonprogressors in the US Department of Defense HIV Natural History Study

• Published in: The Journal of infectious diseases Vol. 200; no. 11; pp. 1714 - 1723
• Main Authors: Okulicz, Jason F., Marconi, Vincent C., Landrum, Michael L., Wegner, Scott, Weintrob, Amy, Ganesan, Anuradha, Hale, Braden, Crum-Cianflone, Nancy, Delmar, Judith, Barthel, Vincent, Quinnan, Gerald, Agan, Brian K., Dolan, Matthew J.
• Format: Journal Article
• Language: English
• Published: Oxford The University of Chicago Press 01.12.2009; University of Chicago Press; Oxford University Press
• Subjects: AIDS; Antiretrovirals; Biological and medical sciences; Chi-Square Distribution; Cohort Studies; Disease Progression; Female; Fundamental and applied biological sciences. Psychology; Health outcomes; HIV; HIV - growth & development; HIV 1; HIV Infections - epidemiology; HIV Infections - virology; HIV Long-Term Survivors - statistics & numerical data; HIV Seropositivity; HIV/AIDS; Human immunodeficiency virus; Humans; Infections; Infectious diseases; Kaplan-Meier Estimate; Male; Medical sciences; Microbiology; Military Personnel; Miscellaneous; Prevalence; RNA; Statistics, Nonparametric; United States; Viral Load; Virology; United States; Virus; Infection; Prognosis; Microbiology; Retroviridae; Human immunodeficiency virus; Lentivirus
• ISSN: 0022-1899; 1537-6613; 1537-6613
• DOI: 10.1086/646609

Durable control of human immunodeficiency virus (HIV) replication and lack of disease progression in the absence of antiretroviral therapy were studied in a military cohort of 4586 subjects. We examined groups of elite controllers (ie, subjects with plasma HIV RNA levels of <50 copies/mL; prevalence, 0.55% [95% confidence interval {CI}, 0.35%–0.80%]), viremic controllers (ie, subjects with plasma HIV RNA levels of 50–2000 copies/mL; prevalence, 3.34% [95% CI, 2.83%–3.91%]), and subjects with a lack of disease progression (ie, long-term nonprogressors [LTNPs]) through 7 years of follow-up (LTNP7s; prevalence, 3.32% [95% CI, 2.70%–4.01%]) or 10 years of follow-up (LTNP10s; prevalence, 2.04% [95% CI, 1.52%–2.68%]). For elite and viremic controllers, spontaneous virologic control was established early and was typically observed when the initial viral load measurement was obtained within 1 year of estimated seroconversion. Elite controllers had favorable time to development of AIDS (P=.048), a CD4 cell count of 350 cells/μL (P=.009), and more-stable CD4 cell trends, compared with viremic controllers. LTNPs defined by 10-year versus 7-year criteria had a longer survival time (P=.001), even after adjustment for differing periods of invulnerability (P=.042). Definitions of controllers and LTNPs describe distinct populations whose differing clinical outcomes improve with the stringency of criteria, underscoring the need for comparability between study populations