HIV-1 elite controllers: Beware of super-infections.

HIV-1 elite controllers: Beware of super-infections.

Super- and co-infection with HIV-1 are generally associated with accelerated disease progression. The authors report on the outcome of super-infection in two HIV-1 infected individuals previously known as elite controllers. Both presented an acute retroviral syndrome following super-infection and showed an immuno-virological progression thereafter. Host genotyping failed to reveal any of the currently recognized protective factors associated with slow disease progression. This report indicates that elite controllers should be informed of the risk of super-infection, and illustrates the complexity of mounting broad anti-HIV immunity.

Editors’ note: Since superinfection was first described in 2002, there have been case reports and reviews but its frequency is difficult to assess. In countries with many circulating recombinant forms of HIV, dual infections are clearly frequent since they are needed for viruses to switch bits of RNA. This report of superinfection in two people injecting drugs in Lausanne who were elite controllers is perplexing. Elite controllers, as opposed to long-term non-progressors, have persistently undetectable viral loads and remain immunocompetent in the absence of antiretroviral therapy. It is estimated that less than 1 per cent of people living with HIV are elite controllers. These two individuals, who were elite controllers for the first years of their HIV infection with subtype B, deteriorated rapidly after becoming infected with a CRF11_cpx recombinant strain. Other HIV-negative people in Lausanne who acquired this recombinant strain did not present an accelerated course of disease. The reasons for both results remain unclear but in the case of superinfection in elite controllers, this case report reinforces the importance of ‘positive health, dignity, and prevention’ as a strategy to avoid superinfection.