Keep control: Elite and post-treatment controllers

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Keep control: Elite and post-treatment controllers MOSY11 Track A. Symposia session Co-Chair: Guinevere Q. Lee PhD, Sarah Fidler MD PhD Share your thoughts on this presentation with #IAS2019

Definition: Elite Control “Low/undetectable viral load and normal CD4 count in the absence of treatment” <1% of the population Progressors Viral load EC Limit of detection Time 714 definitions in 501 EC studies (Gurdasani AIDS 2014).

Definition: Post-treatment Control “Sustained control of viremia after interruption of antiretroviral treatment” Antiretroviral treatment Non-PTC Viral load PTC Limit of detection Time

Mechanism(s) of control HIV-specific CD8+ cytotoxic T cells Neutralizing antibodies ADCC: antibody-dependent cellular cytotoxicity NK cells HIV-specific CD4 cells Dendritic cells Intrinsic host factors / genotypes Intrinsic viral genotypes / integration sites Bodily compartments etc. Created via BioRender.com

Comparison between EC & PTC Elite controllers (EC) Post-Treatment Controllers (PTC) HLA associated Very low HIV reservoirs Immune activation (low) Not HLA associated Low reservoirs Immune activation (low but can be variable)

Learning from EC and PTC… Goals of HIV control: Maintain an undetectable viral load off ART: NO TRANSMISSION Normal immune function: NO CLINICAL RISK HIV sterilizing cure: Undetectable viral load, normal immune function Example: Berlin and London patients (2 cases) HIV remission or “Post-treatment Control”: Example: Mississippi baby, CHER, VISCONTI, very early ART (Asier and Deborah) How do elite controllers differ? (Hendrik and Xu)