[Question #6679] Elite Controller Technical/Scientific question (window period)

15 months ago
So I read an article that claims the window period for elite controllers maybe greater than 12 weeks. Linked here : https://www.bag.admin.ch/dam/bag/de/dokumente/mt/p-und-p/richtlinien-empfehlungen/eksg-rec-window-period-hiv-diagnosis.pdf.download.pdf/eksg-rec-window-period-hiv-diagnosis.pdf

The quote is "Substantially delayed HIV-1 seroconversion, defined as positivity by immune blot >12 weeks after exposure, is rare, anecdotal, and was reported in association with one the following conditions:

Elite controllers (<1% of untreated patients), who can control the HIV viral load without ART,
which results in an atypical and slow development of the antibody response against HIV proteins" It can be found in section 5. 

If thats the case I was curious what you think the window period for an elite controller should be? Considering they are using a generation 4 ag/ab test. 

Im not saying I am one, I know they're rather rare (<2%). Im not questioning my results (as I know they're 99.9% conclusive @ 12 weeks (per the CDC, which many say is being conservative).

 Im just more interested on your thoughts from a knowledged based approach and because you guys know more about this than anyone.

Thanks! 
Edward W. Hook M.D.
Edward W. Hook M.D.
15 months ago

I'm sorry to see you back on the Forum for a 4th time in a month.  I agree with Dr. Handsfield that you appear to be unable to accept your multiple definitive test results using different sorts of test formats and are now trying to continue to find a way to discount your test results which prove that you do not have HIV. Your cherry-picked quotes about the possibly slower development of antibodies to HIV among elite controllers (the reference in Section 5 refers to a single case detected over a decade ago, not a study since, as pointed out in the reference, there are too few elite controllers to make generalizations) miss the point.  Elite controllers DO exist although very rarely (a small fraction of 1% of all persons with HIV,far less than the incorrect >2% figure you use) and there are no good data to describe the time course of how tests for HIV evolve in these persons except to note that such persons DO develop antibodies to the virus and do have positive HIV RNA tests within a week or two of infection.  I will not guess on what that time course with various tests except to state that it is unlikely to be very different from persons who are not elite controllers.

As Dr. warned you about two weeks ago -"Please note the forum does not permit repeated anxiety-driven questions on the same topic or exposure. This will have to be your last one; future new questions about HIV testing and your HIV fears will be deleted without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. I trust you will understand.".  That goes for this post as well which will be closed shortly.  You need to get help in managing your unhealthy inability to accept that you do not have HIV.  EWH

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15 months ago
Im sorry I didn't mean to cherry pick, I wasn't sure how common/rare these situations were, and I didn't realize what I was quoting was only a possibility and not actual facts. 

I appreciate you guys, thank you Doctors!!