Demographics and natural history of HIV-1-infected spontaneous controllers of viremia

Objectives: HIV-1-infected persons spontaneously controlling viremia without treatment (SCV) are rare. Sex and race effects on prevalence and outcome are poorly defined, and it is unclear whether SCV qualitatively or quantitatively differs from typical infection. These issues are examined in this article. Design: Medical records of 46 524 persons receiving outpatient care for HIV-1 infection were reviewed. Of these, 29 811 had adequate viremia testing for SCV screening. Methods: SCVwas defined as at least three consecutive plasma viremia measurements < 50RNAcopies/ml spanning at least 1 yearwithout treatment. SCVloss was defined as at least three consecutive viremia measurements >= 50 RNA copies/ml or one >= 1000 RNA copies/ml. Demographics of persons with SCV were compared with the total population. Viremia and blood CD4(+) T-cell levels during SCV were compared between demographic subgroups and persons who maintained or lost SCV during observation. Results: In total, 53 persons (0.18%) met SCV criteria. Prevalence was higher for women versus men and blacks versus whites; these appeared independent. Loss of SCV was observed at 1.22% per year, and significantly associated with viremia ` blips'. Blip magnitudes fit log-normal distributions with means below 50 RNA copies/ml. Conclusion: Our novel observation of higher SCV prevalence in women and blacks is consistent with prior studies of typical chronic infection. Viremia blips correspond to greater risk of loss of SCV, likely reflecting higher set-point viremia under the limit of detection. Our findings suggest that SCV represents an extreme along a continuum of HIV-1 infection, and not qualitative difference. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.