What are HIV Controllers?

How HIV progresses

A person may start experiencing symptoms within a few weeks of contracting the HIV virus. Many of these symptoms, such as fever, headache, and muscle weakness, resemble signs of the regular flu. This early stage of HIV is considered an acute stage in which the virus is at peak levels in the bloodstream.

The virus specifically attacks CD4 cells, a type of white blood cell (WBC). These cells are critically important for a healthy immune system. The symptoms level off into a stage known as the clinical latency stage. Not all people with HIV experience symptoms, but they’re still considered HIV-positive. HIV controllers are the same in this respect.

One of the primary goals of treating people with HIV is to stop the disease from progressing and compromising the immune system. HIV can progress to AIDS (the final stage of HIV infection) if CD4 levels drop too low.

What makes HIV controllers different?

HIV controllers don’t exhibit the same signs of progression that others do. The amount of the virus in their blood remains low and the CD4 levels remain high, preventing the disease from worsening.

Possible traits that lend themselves to nonprogression include:

• reduced levels of inflammation or swelling in the body
• more efficient immune responses to viruses
• an overall lack of susceptibility to CD4 cell harm

Some researchers believe that HIV controllers have immune system cells that are able to control HIV attacks. However, controllers don’t have any genetic mutations that would suggest they have better immune systems to fight the virus on their own. The exact reason and factors that go into nonprogression are complex and not yet fully understood.

HIV controllers still have the disease despite their differences from other people with HIV. In some controllers, CD4 cells are eventually depleted, though often at a slower rate than in other people with HIV.

How is HIV treated?

Typically, the goal of HIV treatment is to keep the virus from multiplying and killing more CD4 cells. Controlling HIV in this manner helps to prevent transmissions while also stopping damage to the immune system, which may lead to the development of AIDS.

Antiretroviral medications are among the most common treatments because they’ve proven effective in decreasing viral replication. This decrease in replication results in decreased opportunities for HIV to attack healthier CD4 cells. Antiretroviral medications prevent HIV from replicating in the body.

Most people living with HIV need some form of medication to stay healthy and maintain the quality of their lives. A person living with HIV shouldn’t stop taking prescribed HIV medications, even if their symptoms improve. HIV tends to cycle between stages, and some stages may be free of symptoms. Not having any symptoms isn’t necessarily a sign that someone’s an HIV controller, and it isn’t safe to assume so. Transmission and worsening of the condition are still possible.

The virus, however, remains detectable in the blood at very low levels in “regular” controllers. This can lead to chronic inflammation. Researchers recommended antiretroviral medications for controllers but also noted their study was small and called for further, larger studies.

If someone has a viral load that’s lower than 200 copies per milliliter (mL) of blood, then they can’t transmit HIV to others, according to the Centers for Disease Control and Prevention (CDC).

Outlook and future research

HIV controllers may hold key information to finding potential cures for HIV. Further research about how controllers’ immune systems work compared to other people who have HIV is necessary. Scientists may eventually be better able to determine why certain people are long-term nonprogressors.

Controllers can help by participating in clinical studies. Researchers may one day be able to apply the secrets of nonprogression to others with HIV.

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