Elite Controller Definition — SCE Infectious Diseases MCQ

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EasyHIV MedicineElite Controller DefinitionSCE Infectious Diseases

A 28-year-old man with HIV (CD4 620, VL <50 on ART for 5 years) asks about elite controller status. He has been virally suppressed ON ART. Is he an elite controller?

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Correct answer: A — No — elite controllers suppress HIV WITHOUT ART; this patient requires ART for viral suppression and is therefore a 'treatment responder,' not an elite controller

Elite controllers (also called 'HIV controllers') are a rare subset (<0.5%) of PLWH who maintain undetectable VL (<50 copies/mL) WITHOUT ART for prolonged periods (years). This is mediated by potent HIV-specific CD8+ T-cell responses, often associated with protective HLA alleles (HLA-B*57, HLA-B*27). This patient achieves viral suppression WITH ART — he is a normal treatment responder, not an elite controller. The distinction matters because elite controllers are studied for insights into HIV cure strategies.

Reference: BHIVA 2025 – ART guidelines; Lancet HIV 2021 – Elite controllers