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Abstract

Background:We compared sociodemographic, behavioral and clinical characteristics of HIV-infected long-term non-progressors (LTNPs), elite controllers (ECs) and progressors (CPs) to describe differences that may contribute to rates of disease progression. These unique groups of controllers (LTNPs and ECs) provide insights into factors that may influence differential control of HIV infection in the absence of antiretroviral therapy.Methods: An observational study collecting CD4 and viral load data was conducted prospectively between 2002 and 2016. Three groups were purposively selected: LTNP's with sustained CD4 cell counts >500 cells/dl for at least seven years, EC's with suppressed viral loads <400 copies/ml at least six months apart, and progressors with a progressive CD4 count decline from CD4>500. Fishers-exact and Kruskal-Wallis tests compared categorical and continuous data between groups. Results:We identified 24 LTNPs, 15 ECs and 109 CPs. Of these, 87.8% were females and median age was 36.3 years. LTNPs had significantly higher median baseline CD4 counts (897 vs 607; p<0.0001) and BMI (31.9 vs 25.5; p=0.0014) than CPs. At the last visit, the median CD4 count of LTNPs (561 vs 205; p<0.0001) and ECs (639 vs 205; p<0.0001) was higher than CPs. CPs were more likely to have reported alcohol use than ECs (67.9% vs 40%, p=0.045). Conclusions:Our data shows that higher BMI may be a predictor of slower CD4 decline in HIV-infected individuals. Alcohol consumption may hasten disease progression. Understanding these mechanisms requires further research. Universal Test and Treat (UTT) antiretroviral therapy (ART) guidelines make studies on LTNPs and ECs more difficult.