{"id":424,"date":"2009-06-01T10:05:56","date_gmt":"2009-06-01T15:05:56","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=424"},"modified":"2015-06-04T15:30:41","modified_gmt":"2015-06-04T19:30:41","slug":"long-term-nonprogressors-and-hiv-controllers-rare-indeed","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/long-term-nonprogressors-and-hiv-controllers-rare-indeed\/2009\/06\/01\/","title":{"rendered":"“Long-term Nonprogressors” and “HIV Controllers”: Rare Indeed"},"content":{"rendered":"

\"\"<\/a>When giving an overview of HIV pathogenesis to a group of clinicians, Bruce Walker<\/a> usually asks the assembled if they have any patients in their practice who have undetectable viral loads without <\/em>antiretroviral therapy.<\/p>\n

Generally about three-quarters of the audience has at least one such patient.\u00a0 They are then asked to refer them to his research cohort<\/a>, which has a goal of trying to figure out why some patients can control HIV replication without needing antivirals.<\/p>\n

But how common is this “controller” phenomenon really?\u00a0 And how about its immunologic correlate — people with long-term HIV infection but no significant decline in the CD4 cell count?<\/p>\n

Nifty paper in <\/a>AIDS<\/a> <\/em>this month trying to answer this question:\u00a0 Using the French Hospital Database, and starting with over 45,000 potentially eligible patients, the group found that only 69<\/em> were “elite controllers” — that is, had >10 years HIV infection, 90% of viral loads <500 cop\/mL, and most recent viral load <50 cop\/mL.<\/p>\n

Stable CD4s were even less common.\u00a0 Only 25 patients were “elite long-term nonprogressors” — that is, had HIV for more than 8 years, CD4 cells > 600, and no CD4 cell decline.\u00a0 That’s an prevalence of 0.05%, or 5 for every 10,000 patients.<\/p>\n

Medical students and residents sometimes ask me if a particular patient of mine, asymptomatic and not on antiretroviral therapy, is a “long-term nonprogressor.”<\/p>\n

I always respond by asking them what specifically they mean by the term — because as this paper shows, when you look for a truly <\/em>benign course of HIV infection, you need to look pretty darn hard.<\/p>\n","protected":false},"excerpt":{"rendered":"

When giving an overview of HIV pathogenesis to a group of clinicians, Bruce Walker usually asks the assembled if they have any patients in their practice who have undetectable viral loads without antiretroviral therapy. Generally about three-quarters of the audience has at least one such patient.\u00a0 They are then asked to refer them to his […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,4,5,8],"tags":[127,163,164,199,210,231,423,434,438,442,602,749],"class_list":["post-424","post","type-post","status-publish","format-standard","hentry","category-health-care","category-hiv","category-infectious-diseases","category-patient-care","tag-bruce-walker","tag-cd4-cell-count","tag-cd4-cells","tag-clinicians","tag-cohort","tag-controllers","tag-hiv","tag-hiv-infection","tag-hiv-pathogenesis","tag-hiv-replication","tag-medical-students","tag-prevalence"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/424","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=424"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/424\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=424"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=424"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=424"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}