Rate and predictors of progression in elite and viremic HIV-1 controllers

[Background] The proportion of HIV controllers developing virologic, immunological or clinical progression and the baseline predictors of these outcomes have not been assessed in large cohorts. [Methods] A multicenter cohort of HIV controllers was followed from baseline (the first of the three HIV-1 RNA levels < 50 in elite controller or from 50 to 2000 copies/ml in viremic controllers) up to August 2011, to the development of a progression event (loss of viral load control, CD4+ decline, AIDS or death) or to the censoring date (lost to follow-up or initiation of antiretroviral therapy). Predictive models of progression at baseline and a risk score for the combined HIV-1 progression end point were calculated.[Results] Four hundred and seventy-five HIV-1 controllers of whom 204 (42.9%) were elite controller with 2972 person-years of follow-up were identified. One hundred and forty-one (29.7%) patients lost viral load control. CD4+ cell count declined in 229 (48.2%) patients. Thirteen patients developed an AIDS event and four died. Two hundred and eighty-seven (60.4%) developed a combined HIV-1 progression. Baseline predictors for the progression end points and for elite and viremic controller patients were very similar: risk for HIV-1 acquisition, baseline calendar year, CD4+ nadir, viral load before baseline and hepatitis C virus coinfection. The probability of a combined HIV-1 progression at 5 years was 70% for elite controllers with the highest score compared with 13% for those with the lowest.[Methods] A multicenter cohort of HIV controllers was followed from baseline (the first of the three HIV-1 RNA levels < 50 in elite controller or from 50 to 2000 copies/ml in viremic controllers) up to August 2011, to the development of a progression event (loss of viral load control, CD4+ decline, AIDS or death) or to the censoring date (lost to follow-up or initiation of antiretroviral therapy). Predictive models of progression at baseline and a risk score for the combined HIV-1 progression end point were calculated.[Conclusion] HIV-1 disease progression in elite and viremic controllers is frequent. We propose a baseline clinical score to easily classify these patients according to risk of progression. This score could be instrumental for taking clinical decisions and performing pathogenic studies.F.G. is a recipient of a Research Grant from IDIBAPS, Barcelona, Spain. E.R.M. has a grant from Fondo de Investigaciones Sanitarias (FIS) (CP08/00172 and CPII14/00025). Work in CNM is supported by grant SAF 2007-61036 and 2010-17226 from MICINN Spain, by grants 36558/06, 36641/07, 36779/08, 360766/09 from FIPSE Spain and FIS (PI 13/02269) and in part by the RETIC de Investigación en SIDA of the FIS. This work was supported by Redes Telemáticas de Investigación Cooperativa en Salud (RETICS) (RD06/0006/0021, RD12/0017/0036), Consejería de Salud de la Junta de Andalucía (2008, PI-0270, 2009, PI-0066), FIS PS09-00120 and PI13/01912, and Fondo Europeo de Desarrollo Regional (FEDER).Peer reviewe