Elite controllers are the future of HIV treatment reports POZ Magazine

Elite controllers are people living with HIV who are not on antiretroviral drugs, are asymptomatic, and have a robust immune response that actively fights against HIV. According to the National Institutes of Health (NIH), elite controllers currently make up less than 0.5% of people living with HIV, writes POZ.

One Sacramento-based woman, Loreen Willenberg (66), is a landscaped designer who is one of those rare elite controllers. This July marks 29 years since she first achieved an undetectable viral load. Researchers have classified her as an ‘Exceptional Elite Controller’ because she has not shown HIV progression in over 25 years.

Scientists at the NIH used a fluorescent microscopy to record a video of her immune system in action. Willenberg’s CD8 cells attacked HIV-infected CD8 cells far more quickly than they usually do in people living with HIV.

CD8 secretes two substances: A protein called Perforin creates holes in the walls of an infected cells, and the second, an enzyme called Granzyme B slips through these holes and signals the infected CD4 cell to self-destruct.

The NIH determined that Willinberg's CD8 production of Perforin and Granzyme B is several times higher than that of most people living with HIV. “No symptoms, no CD4 loss, and a balanced ratio between my CD4 and CD8 cells,” says Willinberg. “CD8 cells are soldiers who support the general - CD4 cells - in his fight. CD8 are real killers."

In a recent study, scientists were able to uncover the mystery of Willinberg and 60 other Exceptional Elite Controllers. In these people, a genetic copy of HIV is stored in the genome of dormant immune cells in such a way that it cannot be used to produce a new virus. Researchers were unable to find a single intact HIV copy after looking into more than 1.5 billion cells.

Scientists believe that elite HIV controllers often have genetic variations, which they call "gene deserts", that prevent the virus from replicating. These genes contain only inactive viral DNA.

The question now is whether scientists can develop therapies that will enable the millions of ordinary people with HIV to become elite controllers.

Previously we reported about a patient from Buenos Aires who stopped taking ART in 2007 due to exacerbation of lipodystrophy. From then until February 2020 (the date of the last measurement), her viral load has remained at the same undetectable level whilst her CD4 count is also stable at over 500 cells/mm3.