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Human Immunodeficiency Virus 1
(HIV-1) and host organism

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Categories of people in relation to HIV-1 disease

Lately, the International HIV Controller Consortium has somewhat relaxed the requirements that define this population of HIV-infected individuals. Thus, by the new definition, elite controllers are HIV-infected patients with HIV RNA levels below 50 copies/ml) despite the absence of antiretroviral therapy (for at least 1 year at the time of the study). Spikes of viremia up to 1000 copies/ml) are accepted in elite controllers, as long as these episodes are not consecutive and represent the minority of all available determinations.
A temporary increase in VL in someone who previously had undetectable virus and who later returns to having undetectable virus is called blip. The viral load during a blip is usually low (50 to 500 copies/mL).

It is actually impossible to predict whether the resistance to disease progression shown by LTNP and elite controllers will last indefinitely or whether progression to AIDS will eventually be detected in these patients.

Mechanisms that help to maintain undetectable plasma viral loads

Characteristics of CD8+ T cells from elite controllers

Comparison of HIV-1 patients' immunological profiles
progressors -HAART high CD38 and HLA-DR expression (chronically activated) PD-1 high (leads to apoptosis and death)
progressors +HAART low CD38 and HLA-DR expression (not activated) PD-1 low
elite controller low CD38 (not activated) and high HLA-DR expression (a high capacity for expansion) PD-1 low
Conclusion

The activation phenotype of HIV-specific CD8+ T cells with their discordant phenotype in HICs is unusual. This phenotype might indicate optimal activation associated with efficient antiviral activity, whereas high CD38 expression in progressors could be due to high viral load and be driven by cytokines. This deleterious activation status can lead to PD-1 expression, inefficiency, senescence, and, ultimately, apoptosis. By contrast, PD-1 expression by HIV-specific CD8+ T cells is low in HICs.

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