HIV Elite Controllers – the Issue at Heart

Abstract

Background: People with HIV are living longer, and as this population ages, chronic diseases associated with ageing, such as cardiovascular disease, will become of great importance (3). Elite controllers (EC) are a small subset of the HIV population, who maintain viral suppression below the limit of detection in the absence of antiretroviral therapy. Despite non-medical viral control and the absence of HIV-related opportunistic infection, there is concern that their protective immune activation places them at greater risk for coronary atherosclerosis, compared to their medically controlled viremic counterparts (1).

Objective: To summarize literature in a systematic fashion to collect evidence pointing to an association between elite controller status and increased risk of coronary atherosclerosis.

Methods: A structured literature review was conducted using three databases: Scopus, PubMed and Web of Science. The findings were restricted to journal articles and reviews published from 2005-2016. Keywords used for the search were “elite” AND “controller” AND “coronary” OR “cardio”. A total of 4 articles were selected based on the keywords. Article references were screened to include two more articles. The references from those were screened for a total of 6 articles meeting inclusion and exclusion criteria.

Results: Upon review of the articles, two supported the claim that ECs have a higher risk of coronary atherosclerosis than medically controlled HIV viremic patients, one shows no association. Three articles were inconclusive, two because of mixing of results for ECs with viremic controllers (another subpopulation of HIV patients) and one requiring further follow-up.

Conclusion: The findings suggest that there may be an association between HIV EC status and an increased risk of coronary athero-sclerosis compared to medically controlled HIV patients, however, further studies are required in order to confirm this association.