Elite Controllers

People with HIV who can naturally control the virus and have an undetectable viral load without needing antiretroviral treatment are called  "elite controllers". They are a rare group within the broader category of long-term non-progressors. 

About Elite Controllers

• Definition: Elite controllers (or exceptional elite controllers) are individuals whose immune systems can naturally suppress HIV replication to very low, often "undetectable," levels (typically below 50 copies/mL) for an extended period without medication.

• Mechanism: This natural suppression is thought to be due to specific, strong immune responses or certain genetic factors that make their cells resistant to infection.

• Transmission: Because of their naturally suppressed viral load, they fall under the principle of Undetectable = Untransmittable (U=U), meaning they have a negligible or effectively zero risk of sexually transmitting the virus to their partners.  

Key Terminology

• Undetectable = Untransmittable (U=U): This is a key public health message and scientific fact. It states that an individual with HIV who achieves and maintains an undetectable viral load through consistent treatment (or naturally, as in elite controllers) cannot sexually transmit the virus to others.

• Undetectable Viral Load: This means the amount of HIV in the blood is too low to be detected by standard laboratory tests, usually defined as fewer than 200 copies per milliliter of blood.

• Treatment as Prevention (TasP): This refers to the use of antiretroviral therapy (ART) to suppress the viral load and prevent the onward transmission of HIV, which applies to the vast majority of people with HIV who require medication to achieve this status. 

• While the term "elite controllers" describes this specific subset of people who manage the virus without drugs, the concept that an individual with an undetectable viral load does not pass it on is universally known as U=U.

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