Long-term nonprogressor

Long-term nonprogressors (LTNPs), sometimes also called elite controllers, 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. 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.

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:

  • Gene mutation: A mutation in the FUT2 gene affects the progression of HIV-1 infection.[9] 20% of Europeans who have that mutation are called "non secretor" because of their absence of a certain type of antigen that also provides strong resistance against norovirus.[9][10]
  • Mitochondrial DNA: Different mitochondrial DNA haplotypes in humans may increase or decrease rates of AIDS progression. Haplotypes associated with more loosely coupled mitochondrial respiration, with reduced ATP and ROS generation, have been associated with faster progression and vice versa.[11]
  • Receptor mutations: A low percentage of long-term nonprogressors have been shown to have inherited mutations of the CCR5 receptor of T cell lymphocytes. HIV uses CCR5 to enter these cells. It is believed that the Δ32 (delta 32) variant of CCR5 impairs HIV ability to infect cells and cause disease. An understanding of this mechanism led to the development of a class of HIV medicines, the entry inhibitors.[12] The presence of this mutation, however, is not a unifying theme among LTNPs and is observed in an exceedingly small number of these patients.
  • HLA type has also been correlated with long-term non-progressor cohorts. In particular, strong correlations have been found between possessing the class 1 HLA-B*5701,[13] HLA-B*5703,[14] and/or HLA-B*2705[15] alleles and ability to exert control over HIV.
  • Antibody production: All individuals with HIV make antibodies against the virus. In most patients, broadly neutralizing antibodies do not emerge until approximately 2–4 years after the initial infection. At this point, the latent reservoir has already been established and the presence of broadly neutralizing antibodies is not enough to prevent disease progression. In some rare patients, these antibodies emerge earlier and can result in a delayed disease course. These patients, however, are not typically classified as LTNPs, but rather as slow progressors, who will eventually develop AIDS. Induction of broadly neutralizing antibodies in healthy individuals is a potential strategy for a preventive HIV vaccine, as is the elicitation of these antibodies through rationally designed immunogens. Direct production of these antibodies in somatic tissue through plasmid transfection also poses a viable method for making these antibodies endogenously.
  • APOBEC3G protein production: In a small number of people infected with HIV, the virus is naturally suppressed without medical treatment. These people may carry high quantities of a protein called APOBEC3G that disrupts viral replication in cells. APOBEC3G, or "A3" for short, is a protein that sabotages reverse transcription, the process HIV relies on for its replication. This process involves the virus transcribing its single-stranded RNA genome into double-stranded DNA that is incorporated into the cell's genome. A3 usually stops dormant viruses in the human genome, called endogenous retroviruses, from reawakening and causing infections.[16][17]

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 Loreen Willenberg from USA was announced as the first such case[18][19][20] and in 2021 two other cases from Argentina have been presented dubbed "the Buenos Aires patient"[21][22] and "the Esperanza patient"[23][24] after the city/town where they live. All three of them had antiretroviral therapy but stopped the treatment at some point yet even years after their immune systems have kept the virus with no remaining detectable viral load. This could inform the development of a "sterilising cure" therapy.[23]

See also

References

  1. ↑ Michael Carter (12 January 2009). "HIV non-progressor status established soon after infection". Aidsmap. Retrieved 2017-01-17.
  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.
  5. ↑ "HIV+ Long-Term Non-Progressor Study". National Institute of Allergy and Infectious Diseases. June 23, 2010. Archived from the original on July 19, 2011. Retrieved July 5, 2011.
  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.
  8. ↑ Blankson, J. N. (2009). "Effector mechanisms in HIV-1 infected elite controllers: Highly active immune responses?". Antiviral Research. 85 (1): 295–302. doi:10.1016/j.antiviral.2009.08.007. PMC 2814919. PMID 19733595.
  9. 1 2 Kindberg, Elin; Hejdeman, Bo; Bratt, Göran; Wahren, Britta; Lindblom, Bertil; Hinkula, Jorma; Svensson, Lennart (2006). "A nonsense mutation (428G→A) in the fucosyltransferase FUT2 gene affects the progression of HIV-1 infection". AIDS. 20 (5): 685–9. doi:10.1097/01.aids.0000216368.23325.bc. PMID 16514298. S2CID 27932324.
  10. ↑ Thorven, M; Grahn, A; Hedlund, KO; Johansson, H; Wahlfrid, C; Larson, G; Svensson, L (2005). "A homozygous nonsense mutation (428G→A) in the human secretor (FUT2) gene provides resistance to symptomatic norovirus (GGII) infections". J. Virol. 79 (24): 15351–55. doi:10.1128/JVI.79.24.15351-15355.2005. PMC 1315998. PMID 16306606.
  11. ↑ Hendrickson, S. L.; Hutcheson, H. B.; Ruiz-Pesini, E.; Poole, J. C.; Lautenberger, J.; Sezgin, E.; Kingsley, L.; Goedert, J. J.; Vlahov, D.; Donfield, S.; Wallace, D. C.; OʼBrien, S. J. (2008-11-30). "Mitochondrial DNA haplogroups influence AIDS progression". AIDS. 22 (18): 2429–39. doi:10.1097/QAD.0b013e32831940bb. ISSN 0269-9370. PMC 2699618. PMID 19005266.
  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.
  14. ↑ Costello, C.; Tang, J.; Rivers, C.; Karita, E.; Meizen-Derr, J.; Allen, S.; Kaslow, R. A. (1999-10-01). "HLA-B*5703 independently associated with slower HIV-1 disease progression in Rwandan women". AIDS. 13 (14): 1990–91. doi:10.1097/00002030-199910010-00031. PMID 10513667.
  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. ↑ Coghlan, Andy (2013-10-17). "Virus-sabotaging protein may help people defy HIV". New Scientist. Retrieved 2017-01-17.
  17. ↑ 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.
  18. ↑ "Loreen Willenberg's HIV seems to have disappeared. Is this good news for the rest of us?". aidsmap.com. Retrieved 2021-11-16.
  19. ↑ 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.
  20. ↑ 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. doi:10.1038/s41586-020-2651-8. ISSN 1476-4687. PMC 7837306.
  21. ↑ "The Buenos Aires patient: Argentinian woman controls HIV for at least 12 years after stopping treatment". aidsmap.com. Retrieved 2021-11-16.
  22. ↑ Uruena, Analia; Cassetti, Isabel; Kashyap, Neena; Deleage, Claire; Estes, Jacob D; Trindade, Christopher; Hammoud, Dima A; Burbelo, Peter D; Natarajan, Ven; Dewar, Robin; Imamichi, Hiromi (2021-01-01). "Prolonged Posttreatment Virologic Control and Complete Seroreversion After Advanced Human Immunodeficiency Virus-1 Infection". Open Forum Infectious Diseases. 8 (1). doi:10.1093/ofid/ofaa613. ISSN 2328-8957. PMC 7824876. PMID 33511235.
  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. doi:10.7326/l21-0297. ISSN 0003-4819.
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