[Question #4663] Expert advice

28 months ago
First of all I would like to thank you guys for the excellent job you do on here.

I was reading an online forum by a dr paul sax  and came across an answer to one of the posts on elite controllers which seems to contradict previous advice that elite controllers would always test antibody positive.

I was tested at 3months, 6 months, 9 months, 12 months and 18 months for antibody all using 4th generation duo tests other than INSTI rapid test (at 6 months). I also due to anxiety had PCR RNA test at 24months. All tests came back negative.

After reading the post I have become very anxious about the possibility of being an elite controller. The response suggests that some elite controllers have very weak antibody responses over time. Does this mean that the above tests I had taken may have been negative as a result of weak antibody response and possibility that I may be an elite controller? Or would the sensitivity of the tests still be enough to pick up any antibodies? 

I would greatly appreciate your thoughts / answers on my questions as I feel this would enable me to finally beat my anxiety over this whole scenario.

My main questions are:-

1. Do elite controllers have weak antibody responses over time and would these weak antibody responses effect the results of the antibody test?
2. What is the time the post is referring too? (I.e, is this months or years after someone contracting the virus?)

Please see forum post below:-

Terence
September 7, 2016

Thanks Paul. What about Elite Controllers? Could Morgan have identified a case? Where do they fall in the algorithm?

  • Paul Sax
    September 7, 2016

    “Elite controllers” have positive HIV screens then positive differentiation assays for HIV-1. Some do have very weak antibody responses over time, but not permanently (i.e., you’ll detect antibody most of the time).




Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
Welcome to the Forum.  I think you are reading too much into Dr. Sax's statement.  Elite controllers comprise less than 1% of persons with HIV and have a strong immune response to the virus which keeps the amount of circulating HIV virus they have far less than the average person with infection.  As a result, most elite controllers have lower than average results on viral RNA assays and a very small proportion of elite controllers have undetectable viral RNA assays,  They do this because they have had a strong immune response to their infection, both in terms of their cellular immunity and their humoral/antibody immune response  They DO have antibodies however.  As Dr. Sax noted, some initially have weak (but still detectable) antibody responses which tend to then become stronger still over time.  

You don't mention why you think you might be an elite controller but the fact that you can anchor your testing to a specific point in time suggests that you had only one of a few potential exposures.  Even if your exposure was to an infected person, less than 1% of exposures lead to infection and far less than 1% of infected persons are elite controllers.  With five HIV test taken over an 18 month period, if you had HIV- elite controller or not, you would have positive tests.  Please don't worry about this.  EWH  
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28 months ago
Thanks for your response Dr Hook.

My exposure was some five years ago now and my first test was at 3 months with further tests out to 18 months? 

I did think it would be a bit strange if current antibody tests didn’t pick up these 1% of  persons as there would then be a whole lot of people who have been tested but not necessarily correctly diagnosed?

So even though some elite controllers have initially weak antibody responses are these still detectable within the same window period as everyone else? (I.e, 3 months and beyond?)

take it by weak he just meant weaker than everyone else? But they would still be detectable on the tests AT ALL TIMES after window period  as they are very sensitive?
(It’s just Dr Sax uses phrases such as ‘most of the time’)

Sorry if I’m repeating myself just wanted to understand a bit better.




Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
Correct.  "Weak" is a quantitative term for the scientists.  It does not mean undetectable.  Even if you wee an elite controller, you would have a positive test.  Indeed, these tests are VERY sensitive.  Believe your test results.  EWH---
28 months ago
Thanks doctor, your advice is very reassuring.

Perhaps just the way I’m reading things but dr sax states some elite controllers have very weak antibody responses over time and your response suggests they are initially weak and get stronger over time.

I don’t doubt what you saying for a minute, is it just the way I’m reading dr sax statement? Do you think he means very weak initially and over time they increase? 

Do you know what these sort of timescales would be? (I.e are they weak for first few months and then increase or is this hard to quantify?)

Thanks alot
Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
As you know, as this will be my 3rd response and noting that your questions are becoming repetitive, not only with respect to my replies but also with regard to your two earlier interactions with Dr. Handsfield this week, I must reiterate his warning that further repetitive, anxiety driven questions may be deleted without a response and without return of your posting fee.  You seem to be focusing on nuances related to the natural history of HIV antibody responses which are irrelevant to your situation, having already PROVED that you were not infection.  

I do not know about the time course of HIV antibody responses in elite controllers, nor is it an important.  Even in HIV elite controllers, detectable antibodies to HIV are reliably present at any time for that 6 weeks after infection.

You need to ease up on this.  If you cannot, as Dr. Handsfield has already done, I encourage you to consider seeking professional help in addressing why you cannot accept your test results and move forward  EWH
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28 months ago
Dr Hook

One last point just so I’m clear, I take it you meant that elite controllers would have detectable antibodies at six weeks and beyond? (i.e, for the rest of there lives?)

I appreciate your response and for your own information I am seeking professional help to help me get over my anxiety relating to this.

Many Thanks Again for the wonderful job you do.
Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
Correct.  End of thread  EWH---