Hospitalisation among elite controllers
27 May 2014. Related: Conference reports, Treatment strategies, CROI 21 (Retrovirus) 2014.
Elite controllers are sometimes cited as a model of a “functional cure” of HIV infection, because they naturally maintain extremely low viral loads in the absence of ART.
However, in recent years it has become apparent that most elite controllers have elevated levels of immune activation and inflammation compared to HIV negative people, and are not entirely free from the risk of disease progression.
Trevor Crowell presented a poster looking at hospitalisation rates among 149 elite controllers compared to 4,704 HIV positive individuals with suppressed viral loads on ART. 
Elite control was associated with a significantly higher rate of hospitalisation (approximately two-thirds greater), primarily for cardiovascular and pulmonary disease, compared to the cohort on ART. The data are consistent with research indicating that ART may be beneficial for at least some elite controllers,  and also has implications for HIV cure research because it argues that the achievement of virological control in the absence of ART does not necessarily equate to ideal health.
The increasing concern about the time off-ART, above that of simply maintaining a robust CD4 count, has led to less confidence in the earlier idea that HIV may not be pathogenic in elite controllers. The prospect of uncontrolled viraemia for decades in other body sites, however low in plasma, may warrant use of ART, even when CD4 counts remain very high.
This point is also highlighted in recent US (DHHS) guidelines. 
This research should at least prompt individual patient reviews when an earlier decision has been made to defer treatment and monitor.
TAG Basic Science Blog. Catching Up with Pathogenesis and Cure Research from CROI 2014. (16 May 2014).
- Crowell TA et al. HIV elite controllers are hospitalized more often than persons with medically controlled HIV. Poster 556.
- Hatano H et al. Prospective antiretroviral treatment of asymptomatic, HIV-1 infected controllers. PLoS Pathogens. 10 October 2013. DOI: 10.1371/journal.ppat.1003691.
- US DHHS Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents, 01 May 2014. Section page E13.