2. Keep control: Elite and post-treatment controllers
MOSY11
Track A. Symposia session
Co-Chair: Guinevere Q. Lee PhD, Sarah Fidler MD PhD
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3. Definition: Elite Control
“Low/undetectable viral load and normal CD4 count in the absence of treatment”
<1% of the population
Progressors
Viral load EC
Limit of detection
Time
714 definitions in 501 EC studies (Gurdasani AIDS 2014).

4. Definition: Post-treatment Control
“Sustained control of viremia after interruption of antiretroviral treatment”
Antiretroviral treatment
Non-PTC
Viral load
PTC
Limit of detection
Time

5. Mechanism(s) of control
HIV-specific CD8+ cytotoxic T cells
Neutralizing antibodies
ADCC: antibody-dependent cellular cytotoxicity
NK cells
HIV-specific CD4 cells
Dendritic cells
Intrinsic host factors / genotypes
Intrinsic viral genotypes / integration sites
Bodily compartments
etc.
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6. Comparison between EC & PTC
Elite controllers (EC)
Post-Treatment Controllers (PTC)
HLA associated
Very low HIV reservoirs
Immune activation (low)
Not HLA associated
Low reservoirs
Immune activation (low but can be variable)

7. Learning from EC and PTC…
Goals of HIV control:
Maintain an undetectable viral load off ART: NO TRANSMISSION
Normal immune function: NO CLINICAL RISK
HIV sterilizing cure:
Undetectable viral load, normal immune function
Example: Berlin and London patients (2 cases)
HIV remission or “Post-treatment Control”:
Example: Mississippi baby, CHER, VISCONTI, very early ART (Asier and Deborah)
How do elite controllers differ? (Hendrik and Xu)