What Are HIV Controllers?

Medically reviewed by Timothy J. Legg, PhD, CRNP on August 8, 2016Written by Kristeen Cherney on September 11, 2014

Managing HIV

HIV is a lifelong condition that may eventually lead to AIDS. HIV can act differently in different people. People with the virus normally require treatment to prevent life-threatening complications. A small quantity of people with HIV can handle the infection without any apparent problems. These people are known as “HIV controllers” or “long-term nonprogressors.”

Infection with HIV causes no symptoms in HIV controllers. The virus remains at low levels in their bodies. They can continue to survive and thrive without treatment as a result. Controllers also show no signs of progression from HIV infection 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.

Read more about these unique people, why they’re different, and what their conditions may mean for HIV research.

How HIV progresses

HIV is a chronic, lifelong condition. You may start experiencing symptoms within a few weeks of contracting the 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. 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 carriers of the virus. 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 progresses to AIDS if CD4 levels drop too low.

What makes HIV controllers different?

HIV controllers don’t exhibit the same signs of progression. The amount of the virus in their blood remains low, 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. They’re also still able to transmit it to others. An HIV controller may expose others to the virus without even knowing it. Furthermore, CD4 counts are still depleted in controllers. They are, however, depleted at a slower rate than in other people with HIV.

How is HIV treated?

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 infections while also stopping damage to the immune system, which ultimately leads to AIDS.

Antiretroviral therapy (ART) 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. ART medications prevent HIV from replicating in the body.

It’s important to note that it isn’t safe to assume you’re an HIV controller. Most people with HIV need some form of medication to improve the quality and length of their lives. Don’t stop taking prescribed HIV medications, even if you’re feeling better. HIV tends to cycle between stages, some of which may be free of symptoms. Not having any symptoms isn’t necessarily a sign that you’re an HIV controller. Transmission and worsening of your condition are still possible.

Controllers may show negative effects of the disease, such as elevated immune activation and inflammation. In a study published by PLOS Pathogens, researchers investigated the effect of ART 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 infection remains present, blood tests are unable to detect measurable levels of HIV in the blood. These people remain completely asymptomatic without any ART.

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

Outlook and future research

HIV controllers may hold key information to finding potential HIV and AIDS cures. 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.

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