Strenuous resistance to natural HIV-1 disease progression: Viral controllers and long-term nonprogressors

HIV-1 infection leads to AIDS and death within 8-10 years for most individuals in the absence of antiretroviral therapy (ART). However, a minority of infected individuals show the unusual capacity to spontaneously control disease progression after infection in the absence of any ART. So-called 'long-term nonprogressors' are defined by maintenance of peripheral CD4 + T-cell counts >500 cells/μl and good health without ART for >7 years since infection. More recently, ART-naive individuals who spontaneously control their viremia levels at either <50 or <2000 copies of RNA/ml for at least 12 months in the absence of ART have been named 'elite controllers' and 'HIV controllers', respectively. The overlap between long-term nonprogressors and elite controllers/HIV controllers is partial, and both groups collectively account for <5% of all infected individuals. Unraveling the nature of their relative resistance to HIV-1 disease progression would be of great value for HIV-prevention strategies.