HIV controllers: to treat or not to treat? Is that the right question?

Nicolas Noël (1, 2, 3) , Asier Sáez-Cirión (4) , Véronique Avettand-Fenoel (5, 6) , Faroudy Boufassa (7) , Olivier Lambotte (1, 2, 3)

1 IMVA - U1184 - Immunologie des Maladies Virales et Autoimmunes
2 IDMIT - Infectious Diseases Models for Innovative Therapies
3 Service de médecine interne et maladies infectieuses
4 HIV, Inflammation et persistance - HIV, Inflammation and Persistence
5 IC UM3 (UMR 8104 / U1016) - Institut Cochin
6 Laboratoire de Microbiologie Clinique [AP-HP Hôpital Necker-Enfants Malades]
7 CESP - Centre de recherche en épidémiologie et santé des populations

The term HIV controller refers to the small proportion of individuals infected with HIV who can spontaneously control viraemia to maintain very low viral loads. One major unresolved question is whether HIV controllers should receive antiretroviral therapy, given that international guidelines recommend treatment for all individuals who are infected with HIV. Differences in the definitions of a controller (in terms of the viral-load cutoff and the duration of viral control) and contrasting reports on CD4 T-cell decline, chronic immune activation, the cardiovascular risk, and loss of viral control in controllers have prevented the development of a consensus view.

Domains: Life Sciences [q-bio]; Life Sciences [q-bio]; Human health and pathology; Life Sciences [q-bio]; Human health and pathology; Infectious diseases

Nicolas Noël, Asier Sáez-Cirión, Véronique Avettand-Fenoel, Faroudy Boufassa, Olivier Lambotte. HIV controllers: to treat or not to treat? Is that the right question?. Lancet HIV, 2019, 6 (12), pp.e878-e884. ⟨10.1016/S2352-3018(19)30264-4⟩. ⟨pasteur-02549942⟩