[Question #6349] elite controllers window period and testing

16 months ago
Hello,

I have been browsing through the questions on your website and noticed that few people are asking about elite controllers. Moreover, I got interested to know more about this topic so I have been researching papers, studies, articles and stories about those cases. I would really love to hear your feedback on this, since I did not find a proper response regarding those on this website. I really admire your research and your work, and this is why I am writing to you.

First of all, I started with this paper where authors explain "outliers" detected through HIV testing longer than 12 weeks ( this is referenced in page 8).  As authors mentioned, the main reason why part of elite controllers remain undectetable during a long period of time is their lack of viral RNA and low level of proviral DNA in blood.

Second paper is confirming the previous study by showing the real life data for elite controllers who remained undetectable by testing with 4th generation tests (you can check the in chapter 5 "conclusion" third paragraph). 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4319362/

Finnally, this article is stating that some cases took more than 8 years to test positive by using any of the tests, including PCR/NAT, AgAb 
https://www.thebodypro.com/article/elite-controllers-sex-differences-and-factors-asso

I am addressing following question to you:
1. Is estimation of elite controllers correct (less than 1%), because they are detected by "luck" - testing frequently every few months for a really long period of time.
2. Is there an indicator to suspect that someone is an elite controller (ie. hospitalization due to inflammation)?
3. what is the best advice to do while testing (which tests and when) to confirm that someone is not elite controller?

Thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
16 months ago
 Welcome to our forum. Thanks for your question. I will do you my best to answer your questions. 

Please remember that there are so few elite controllers for HIV that there are no substantial series which have been scientifically study. Also please remember that elite control represents a successful immunologic host response to infection.   As a result many elite controllers DO develop antibodies to HIV.  The elite controller state is defined by low or undetectable viral RNA levels in the absence of HIV therapy.

 In answer to your questions: 
1.   Most elite controller's are detected on the basis of positive antibody tests  which are taken at sometime after acquisition of infection.   So, I guess, that you could say that elite controllers are discovered as a matter of "luck".
2.   No, as noted above, there is rarely if ever a specific indicator that someone is an elite controller until they are found to have a positive antibody test and low or undetectable viral RNA levels. 
3.   I am not sure what this question means. As mentioned above most elite controllers are detected on the basis of a positive antibody test. Please realize that elite control of HIV is extraordinarily rare and that if your HIV test is negative you are almost certainly not HIV infected. 

 I hope this information is helpful. In years of working with patients at risk for HIV as well as on this forum we have never seen a person who comes to the forum and thinks that they might be an elite controller prove to be one. Take care.  EWH 
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