How elite controllers cope with HIV

Human immunodeficiency virus is an incurable disease that attacks white blood cells, weakening the immune system. Because of this, people who do not control the infection become more susceptible to other serious illnesses. For example, tuberculosis, meningitis, bacterial infections and some types of cancer.

In the “ Yod ” telegram channel we tell you how to take care of your health based on evidence-based medicine.

HIV is transmitted through body fluids: blood, semen, vaginal secretions, breast milk. But at the same time, the disease cannot be contracted, for example, during a kiss or drinking from the same mug.

Who are elite HIV controllers?

Elite controllers are people with HIV whose body can maintain a suppressed viral load without special therapy. This means that the level of CD4 cells, which HIV normally attacks and destroys, either remains the same or decreases slightly. Due to this, carriers of the virus have a lower risk of developing AIDS.

This does not mean that elite controllers are completely protected from the final stages of the disease. In an ordinary person, without treatment, HIV develops into AIDS in 10–15 years. This can also happen with a controller, but later. The reason is that the virus continues to replicate in the blood . And sooner or later containment may break down.

Scientists also know of cases where a suppressed viral load for several months or years was observed in people who stopped HIV therapy. They are called post-treatment controllers. In normal situations, after refusing treatment, the disease begins to progress.

How elite controllers cope with HIV

Nobody knows this for sure yet . There are very few controllers, only 0.5% of all infected. Therefore, scientists’ samples are also small. This means that theories require careful testing and confirmation.

Researchers have an assumption that it all comes down to special viral reservoirs. These are cells or areas thereof in which the virus can remain hidden and persist without causing symptoms of the disease. There it can still reproduce, but not as actively as in other parts of the body.

In elite controllers, the reservoirs in which the “dormant” HIV is located consist of groups of particles that have a similar structure. In the body, they are arranged in an organized manner – such a distribution may help in sustainable control of the virus, because perhaps the immune system is better able to recognize and fight orderly clumps of cells.

Another feature of viral reservoirs that may influence disease control is the location of HIV particles in the human genome. For controllers, parts of the virus that are responsible for its reproduction may be located in different places. And the places with viral sequences are located far from the places where DNA copying begins.

To start replicating DNA, the particles need to “meet” and get to the copying site – and due to the special location, this process will take longer than for a non-controller. All this helps slow down the progression of the disease.

How elite HIV controllers can help science

The study of elite controllers allows for in-depth exploration of the mechanisms by which the virus is controlled:

• Although elite controllers show sustained suppression of HIV, some are still infected with a type of virus that can replicate. Studying it will help you understand the characteristics of tanks and boxes.
• Research will allow us to find out where the sites of viral DNA insertion are located in HIV controllers. And this may indicate factors that contribute to the suppression of the virus.
• If the controller begins to suppress the virus very early in the infection, scientists have the opportunity to expand knowledge of how the body responds to HIV almost immediately after infection.

Why HIV is still a problem

HIV is preventable, but many people get it every year. For example, in 2022 , 1.3 million cases were identified worldwide .

The virus spreads easily in the first few months after infection, but many are unaware of their status until later stages because HIV is easily confused with other conditions. Among the signs that should alert you:

• heat,
• headache,
• rash,
• sore throat,
• enlarged lymph nodes,
• weight loss,
• diarrhea,

There is no medicine that can completely cure the disease. And so far, only five cases of remission are known in patients diagnosed with HIV. People recovered after chemotherapy and antiretroviral therapy, as well as stem cell transplantation. But no one knows whether the remission was a consequence or a mere coincidence. And the latter method is considered completely unethical for treating HIV , because it greatly increases the likelihood of death, and the possible benefits do not always outweigh the risks.

Fortunately, it is now possible to reduce the viral load and risk of HIV transmission by 96%. This is done with antiretroviral therapy, consisting of one or more drugs. By controlling the disease, a person can live a healthy and productive life: have children, travel, get piercings and tattoos. But certain restrictions remain. So, you cannot donate blood and breastfeed your children.

How can you protect yourself from HIV?

Preventative measures to prevent infection are quite simple :

• Choose less risky sex, such as oral, intramammary, or petting.
• Use condoms during any sex, whether vaginal, oral or anal.
• Stop injecting drugs. If that doesn’t work, use new, clean syringes and throw away used ones.
• Do not share personal hygiene items, such as razors, with other people.
• Encourage your partner to start or continue taking antiretroviral therapy if they have HIV.
• Use pre-exposure prophylaxis (PrEP) before sex or injections if there is doubt about the partner’s status or the syringe is being reused.
• Get circumcised: This is necessary, according to experts, because the skin under the foreskin is easily chafed and damaged during sex , making it easier to get infections.

Get tested for HIV to start receiving treatment as early as possible and reduce the risks of the disease. You need to do this at least once in your life. And people from risk groups who have sex without contraception, including anal, take injecting drugs, or have encountered sexually transmitted infections, should undergo examination at least once a year.

WHO also recommends the use of cabotegravir, a drug that can be used as a prevention option for people at high risk of contracting HIV. It is worth remembering that this is not a vaccination, so a person does not develop immunity to the disease. But the likelihood of infection is still reduced. Injections are recommended every 4–8 weeks.

Now in Russia this drug is difficult to get, and it is very expensive – from 132 thousand rubles for 600 mg. This is enough for just one injection.