Most studies have concluded that ECs control the infection via virus-specific T cell-mediated immune responses, which differ from non-controllers in a number of ways. These include defective HIV-1 variants, innate resistance to HIV-1 infection, limited availability of susceptible CD4 + T cell targets and an immune-based control of viral replication. Various hypotheses have been put forward to explain the spontaneous virological control as seen in ECs. In this review, we shall describe the various immunovirological mechanisms that have been suggested as supporting the EC phenotype and review the various therapeutic options in this group of ndividuals. Furthermore, because of their potential for clinical progression in this population, there have been questions asked recently regarding the need for treatment initiation even when virological control was present. However, the mechanisms underlying virological control remain. Their spontaneous virological control should be ideally replicated more widely in HIV-1-positive individuals and is therefore of great research interest. Compared with VCs and LTNPs, ECs represent a smaller subset of less than 1% of all individuals with HIV-1. The subset of ECs was further distinguished from viraemic controllers (VCs) and long-term non-progressors (LTNPs) primarily on the basis of their VL level. ![]() However, some of them may lose virological control and progress overtime both virologically and also clinically to AIDS-defining conditions. Various definitions have been applied to these individuals, known as elite controllers (ECs). Several years after the discovery of the HIV type 1 (HIV-1), a small subset of individuals was identified with a rare ability to spontaneously maintain an undetectable viral load (VL) in the absence of previous or ongoing antiretroviral therapy (ART).
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