Managing HIV

HIV is a chronic, lifelong condition. People living with HIV normally take daily antiretroviral therapy to stay healthy and prevent complications. However, a small number of people who contract HIV can live with the virus without needing treatment. These people are known as “HIV controllers” or “long-term nonprogressors,” depending on whether the viral load or CD4 is being examined.

Contracting HIV causes no symptoms in HIV controllers. The virus remains at low levels in their bodies. As a result, they can continue to survive and thrive without treatment. Controllers also show no signs of progression from HIV to AIDS. HIV controllers are nonetheless considered to be HIV-positive. They may enjoy a good quality of life, but they aren’t technically considered cured. Fewer than 1 percent of people with HIV are considered to be HIV controllers.

Read more about these unique people and what their conditions may mean for HIV research.

A person may start experiencing symptoms within a few weeks of contracting the HIV virus. Many of these symptoms, such as fever, headache, and muscle weakness, resemble signs of the regular flu. This early stage of HIV is considered an acute stage in which the virus is at peak levels in the bloodstream.

The virus specifically attacks CD4 cells, a type of white blood cell (WBC). These cells are critically important for a healthy immune system. The symptoms level off into a stage known as the clinical latency stage. Not all people with HIV experience symptoms, but they’re still considered HIV-positive. HIV controllers are the same in this respect.

One of the primary goals of treating people with HIV is to stop the disease from progressing and compromising the immune system. HIV can progress to AIDS (the final stage of HIV infection) if CD4 levels drop too low.

HIV controllers don’t exhibit the same signs of progression that others do. The amount of the virus in their blood remains low and the CD4 levels remain high, preventing the disease from worsening.

Possible traits that lend themselves to nonprogression include:

  • reduced levels of inflammation or swelling in the body
  • more efficient immune responses to viruses
  • an overall lack of susceptibility to CD4 cell harm

Some researchers believe that HIV controllers have immune system cells that are able to control HIV attacks. However, controllers don’t have any genetic mutations that would suggest they have better immune systems to fight the virus on their own. The exact reason and factors that go into nonprogression are complex and not yet fully understood.

HIV controllers still have the disease despite their differences from other people with HIV. In some controllers, CD4 cells are eventually depleted, though often at a slower rate than in other people with HIV.

Typically, the goal of HIV treatment is to keep the virus from multiplying and killing more CD4 cells. Controlling HIV in this manner helps to prevent transmissions while also stopping damage to the immune system, which may lead to the development of AIDS.

Antiretroviral medications are among the most common treatments because they’ve proven effective in decreasing viral replication. This decrease in replication results in decreased opportunities for HIV to attack healthier CD4 cells. Antiretroviral medications prevent HIV from replicating in the body.

Most people living with HIV need some form of medication to stay healthy and maintain the quality of their lives. A person living with HIV shouldn’t stop taking prescribed HIV medications, even if their symptoms improve. HIV tends to cycle between stages, and some stages may be free of symptoms. Not having any symptoms isn’t necessarily a sign that someone’s an HIV controller, and it isn’t safe to assume so. Transmission and worsening of the condition are still possible.

Controllers may show negative effects of the disease, such as elevated immune activation and inflammation, even if viral replication is not detected. In a study published by PLOS Pathogens, researchers investigated the effect of antiretroviral medications in controllers. They found that medications reduced the amount of HIV RNA and other HIV markers in controllers. The medication also reduced activation of the immune system. The researchers determined that HIV does continue to replicate in all but a very few controllers who are referred to as “elite controllers.” In these elite controllers, although the virus remains present, blood tests are unable to detect measurable levels of HIV in the blood. These people remain completely asymptomatic without antiretroviral medications.

The virus, however, remains detectable in the blood at very low levels in “regular” controllers. This can lead to chronic inflammation. Researchers recommended antiretroviral medications for controllers but also noted their study was small and called for further, larger studies.

If someone has a viral load that’s lower than 200 copies per milliliter (mL) of blood, then they can’t transmit HIV to others, according to the Centers for Disease Control and Prevention (CDC).

HIV controllers may hold key information to finding potential cures for HIV. Further research about how controllers’ immune systems work compared to other people who have HIV is necessary. Scientists may eventually be better able to determine why certain people are long-term nonprogressors.

Controllers can help by participating in clinical studies. Researchers may one day be able to apply the secrets of nonprogression to others with HIV.