Long-term nonprogressor

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Long-term nonprogressors (LTNPs), are individuals infected with HIV, who maintain a CD4 count greater than 500 without antiretroviral therapy with a detectable viral load. [1] Many of these patients have been HIV positive for 30 years without progressing to the point of needing to take medication in order not to develop AIDS.[ citation needed ] They have been the subject of a great deal of research, since an understanding of their ability to control HIV infection may lead to the development of immune therapies or a therapeutic vaccine. [2] The classification "Long-term non-progressor" is not permanent, because some patients in this category have gone on to develop AIDS.[ citation needed ]

Contents

Long-term nonprogressors typically have viral loads under 10,000 copies /mL blood, [3] do not take antiretrovirals, and have CD4+ counts within the normal range. [4] Most people with HIV not on medication have viral loads which are much higher.

It is estimated that around 1 in 500 people with HIV are long-term nonprogressors. [5] Without the symptoms of AIDS, many LTNP patients may not know they are infected. [6]

Genetic traits that confer greater resistance or more robust immune response to HIV are thought to explain why LTNP patients are able to live much longer with HIV than patients who are not LTNP. [7] [8] Some LTNP are infected with a weakened or inactive form of HIV, but it is now known that many LTNP patients carry a fully virulent form of the virus. Genetic traits that may affect progression include:

The 'long-term nonprogressors' term is used for HIV carriers only but the wide term asymptomatic carrier is well known for many other infections.

Clearance of the virus

Recently, there have been reports of elite controllers who maintain undetectable viral loads. In 2019, an American named Loreen Willenberg was announced as the first such case. [20] [21] [22] In 2021, an Argentinian dubbed "the Esperanza patient" [23] [24] after the town in which she lives was also identified. Willemberg had received antiretroviral therapy but stopped treatment at some point. The Argentinian patient took antiretroviral therapy only while pregnant, but her viral load was nevertheless reported to be undetectable years after treatment discontinuation. This could inform the development of a "sterilising cure." [23]

See also

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References

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  2. ↑ "Understanding Long-term Nonprogressors". International AIDS Vaccine Initiative. Archived from the original on October 9, 2006. Retrieved December 4, 2007.
  3. ↑ Poropatich, Kate; Sullivan, David J. (2010). "Human immunodeficiency virus type 1 long-term non-progressors: the viral, genetic and immunological basis for disease non-progression". Journal of General Virology. 92 (2): 247–268. doi: 10.1099/vir.0.027102-0 . PMID   21106806.
  4. ↑ Rhodes, DI; Ashton, L; Solomon, A; Carr, A; Cooper, D; Kaldor, J; Deacon, N (November 2000). "Characterization of three nef-defective human immunodeficiency virus type 1 strains associated with long-term nonprogression. Australian Long-Term Nonprogressor Study Group". J. Virol. 74 (22): 10581–88. doi:10.1128/jvi.74.22.10581-10588.2000. PMC   110932 . PMID   11044102.
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  6. ↑ Walker, BD (2007). "Elite control of HIV Infection: implications for vaccines and treatment". Top HIV Med. 15 (4): 134–6. PMID   17720999.
  7. ↑ O'Connell, K. A.; Bailey, J. R.; Blankson, J. N. (2009). "Elucidating the elite: mechanisms of control in HIV-1 infection". Trends in Pharmacological Sciences. 30 (12): 631–637. doi:10.1016/j.tips.2009.09.005. PMID   19837464.
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  12. ↑ Lambotte, Olivier; Boufassa, Faroudy; Madec, Yoann; Nguyen, Ahn; et al. (2005). "HIV controllers: a homogeneous group of HIV-1-infected patients with spontaneous control of viral replication". Clinical Infectious Diseases. 41 (7): 1053–56. doi: 10.1086/433188 . PMID   16142675.
  13. ↑ Migueles, S. A.; Sabbaghian, M. S.; Shupert, W. L.; Bettinotti, M. P.; Marincola, F. M.; Martino, L.; Hallahan, C. W.; Selig, S. M.; Schwartz, D.; Sullivan, J.; Connors, M. (2000-02-29). "HLA B*5701 is highly associated with restriction of virus replication in a subgroup of HIV-infected long term nonprogressors". Proceedings of the National Academy of Sciences. 97 (6): 2709–2714. Bibcode:2000PNAS...97.2709M. doi: 10.1073/pnas.050567397 . ISSN   0027-8424. PMC   15994 . PMID   10694578.
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  15. ↑ Almeida, J. R.; Price, D. A.; Papagno, L.; Arkoub, Z. A.; Sauce, D.; Bornstein, E.; Asher, T. E.; Samri, A.; Schnuriger, A.; Theodorou, I.; Costagliola, D.; Rouzioux, C.; Agut, H.; Marcelin, A.-G.; Douek, D.; Autran, B.; Appay, V. (2007-09-24). "Superior control of HIV-1 replication by CD8+ T cells is reflected by their avidity, polyfunctionality, and clonal turnover". Journal of Experimental Medicine. 204 (10): 2473–2485. doi:10.1084/jem.20070784. ISSN   0022-1007. PMC   2118466 . PMID   17893201.
  16. ↑ Daniela Benati, Moran Galperin, Olivier Lambotte, Stéphanie Gras, Annick Lim, Madhura Mukhopadhyay, Alexandre Nouël, Kristy-Anne Campbell, Brigitte Lemercier, Mathieu Claireaux, Samia Hendou, Pierre Lechat, Pierre de Truchis, Faroudy Boufassa, Jamie Rossjohn, Jean-François Delfraissy, Fernando Arenzana-Seisdedos, Lisa A Chakrabarti (2016). "Public T cell receptors confer high-avidity CD4 responses to HIV controllers". Journal of Clinical Investigation. 126 (6): 2093–2108. doi:10.1172/JCI83792. PMC   4887161 . PMID   27111229.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  17. ↑ Abena K Kwaa , Joel N Blankson (2024). "Immune Responses in Controllers of HIV Infection". Annu Rev Immunol. 42 (1): 21–33. doi:10.1146/annurev-immunol-083122-035233. PMID   37827174.
  18. ↑ Coghlan, Andy (2013-10-17). "Virus-sabotaging protein may help people defy HIV". New Scientist . Retrieved 2017-01-17.
  19. ↑ De Pasquale, MariaPia; Kourteva, Yordanka; Allos, Tara; d'Aquila, Richard T.; Unutmaz, Derya (16 October 2013). "Lower HIV Provirus Levels Are Associated with More APOBEC3G Protein in Blood Resting Memory CD4+ T Lymphocytes of Controllers In Vivo". PLOS ONE. 8 (10): e76002. Bibcode:2013PLoSO...876002D. doi: 10.1371/journal.pone.0076002 . PMC   3797809 . PMID   24146808.
  20. ↑ "Loreen Willenberg's HIV seems to have disappeared. Is this good news for the rest of us?". aidsmap.com. 3 September 2020. Retrieved 2021-11-16.
  21. ↑ Mandavilli, Apoorva (2020-08-26). "A Woman May Have Been Cured of H.I.V. Without Medical Treatment". The New York Times. ISSN   0362-4331 . Retrieved 2021-11-16.
  22. ↑ Jiang, Chenyang; Lian, Xiaodong; Gao, Ce; Sun, Xiaoming; Einkauf, Kevin B.; Chevalier, Joshua M.; Chen, Samantha M. Y.; Hua, Stephane; Rhee, Ben; Chang, Kaylee; Blackmer, Jane E. (26 August 2020). "Distinct viral reservoirs in individuals with spontaneous control of HIV-1". Nature. 585 (7824): 261–267. Bibcode:2020Natur.585..261J. doi:10.1038/s41586-020-2651-8. ISSN   1476-4687. PMC   7837306 . PMID   32848246.
  23. 1 2 "Rare case of woman's body ridding itself of HIV". BBC News. 2021-11-16. Retrieved 2021-11-16.
  24. ↑ Turk, Gabriela; Seiger, Kyra; Lian, Xiaodong; Sun, Weiwei; Parsons, Elizabeth M.; Gao, Ce; Rassadkina, Yelizaveta; Polo, Maria Laura; Czernikier, Alejandro; Ghiglione, Yanina; Vellicce, Alejandra (2021-11-16). "A Possible Sterilizing Cure of HIV-1 Infection Without Stem Cell Transplantation". Annals of Internal Medicine. 175 (1): 95–100. doi:10.7326/l21-0297. ISSN   0003-4819. PMC   9215120 . PMID   34781719. S2CID   244131565.
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