A small group of people infected with HIV virus, called elite suppressors have the ability to naturally control infection in absence of antiretroviral therapy or HAART. Elite suppressors and HIV- infected individuals treated with HAART have similar levels of virus in the blood stream. However, levels of HIV integrated into immune cells are much lower in elite suppressors compared to levels in cells from HIV-infected individuals on HAART, according to a study by University of Pennsylvania School of Medicine researchers published in PLoS Pathogens.
Elite suppressors are thought to have a more effective immune response to HIV; specifically, more effective killer T cells, the subgroup of white blood cells that kill cells infected with viruses. HIV is an RNA virus that converts its RNA genome into DNA intermediates in order to replicate. One important step in the HIV life cycle is integration - where HIV DNA inserts into the chromosomes of human helper T cells. Cells that contain the integrated form of HIV DNA and are metabolically less active appear to be resistant to antiretroviral therapy and persist in the host, forming a latent reservoir. It will be important to understand why the HIV reservoir is lower in elite suppressors than in HIV infected individuals on HAART. To begin to address this question, it would be interesting to see if the level of integration would be lower still after placing elite suppressors on HAART. The investigators speculate that therapeutic vaccinations aimed at generating killer T cells similar to those in elite suppressors may be effective against the treatment resistant latent reservoir.