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Home / AIDS, Volume 30, Number 8

Rate and predictors of progression in elite and viremic HIV-1 controllers

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Background:

The proportion of HIV controllers developing virologic, immunological or clinical progression and the baseline predictors of these outcomes have not been assessed in large cohorts.Methods:

A multicenter cohort of HIV controllers was followed from baseline (the first of the three HIV-1 RNA levels < 50 in elite controller or from 50 to 2000 copies/ml in viremic controllers) up to August 2011, to the development of a progression event (loss of viral load control, CD4+ decline, AIDS or death) or to the censoring date (lost to follow-up or initiation of antiretroviral therapy). Predictive models of progression at baseline and a risk score for the combined HIV-1 progression end point were calculated.Results:

Four hundred and seventy-five HIV-1 controllers of whom 204 (42.9%) were elite controller with 2972 person-years of follow-up were identified. One hundred and forty-one (29.7%) patients lost viral load control. CD4+ cell count declined in 229 (48.2%) patients. Thirteen patients developed an AIDS event and four died. Two hundred and eighty-seven (60.4%) developed a combined HIV-1 progression. Baseline predictors for the progression end points and for elite and viremic controller patients were very similar: risk for HIV-1 acquisition, baseline calendar year, CD4+ nadir, viral load before baseline and hepatitis C virus coinfection. The probability of a combined HIV-1 progression at 5 years was 70% for elite controllers with the highest score compared with 13% for those with the lowest.Conclusion:

HIV-1 disease progression in elite and viremic controllers is frequent. We propose a baseline clinical score to easily classify these patients according to risk of progression. This score could be instrumental for taking clinical decisions and performing pathogenic studies.

Keywords: HIV-1 progression; controllers; predictive model

Document Type: Research Article

Affiliations: 1: Hospital Clinic-Fundació Clinic, HIVACAT, Universidad de Barcelona, Barcelona, Members of the EC and Immune Pathogenesis Working Group of the Spanish AIDS Research Network are listed in the Acknowledgements. 2: Hospital Clinic-Fundació Clinic, HIVACAT, Universidad de Barcelona, Barcelona 3: Laboratory of Immunovirology, Biomedicine Institute of Seville, Infectious Disease Unit, Virgen del Rocio University Hospital, University of Seville, Seville 4: IIS-Fundación Jiménez Diaz, UAM, Madrid, Hospital Universitario rey Juan Carlos, Móstoles 5: Centro Nacional de Microbiología ISCIII 6: AIDS Immunopathology Laboratory, ISCIII, Madrid 7: Hospital la Fe, Valencia 8: Centro Sanitario Sandoval, Madrid 9: Hospital Trias i Pujol de Can Ruti, Badalona 10: Hospital Donostia, San Sebastian, Spain.

Publication date: 15 May 2016

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