October 4, 2012

Cardiovascular Disease Risk Remains High in HIV Elite Controllers

More evidence that immune activation and inflammation are key drivers of the increased cardiovascular disease risk among people living with HIV: Elite controllers—a rare subset of HIV-positive individuals who maintain undetectable viral loads and high CD4 cell counts in the absence of antiretroviral therapy—have significant plaque hardening of the arteries (atherosclerosis), according to the results of a study published online ahead of print by the journal AIDS.

“We demonstrate an unexpectedly high degree of coronary atherosclerosis and elevated markers of immune activation in [elite controllers],” the Harvard University-affiliated researchers wrote. “Interestingly, the degree of atherosclerosis was similar, if not greater, compared to [people living with HIV] receiving long-term [antiretroviral therapy] with suppressed viremia.”

The study enrolled 10 HIV elite controllers, 103 people living with HIV with undetectable viral loads while receiving antiretroviral therapy and 49 HIV-negative individuals.

The prevalence of arterial plaques was 78 percent among the elite controllers, compared with 42 percent of the HIV-negative study volunteers.  Among those with HIV infection receiving treatment, the prevalence was 60 percent.

The researchers conclude that the “precise interplay” between immune activation, the highly effective HIV-specific T-cell responses that differentiate many of those with elite control of the virus and those with chronic infection, low-level HIV replication and cardiovascular disease “need to be fully elucidated in larger studies” of elite controllers.

To read the AIDS report, click here (paid subscription required).

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