HIV controllers: to treat or not to treat? Is that the right question?

Lancet HIV. 2019 Dec;6(12):e878-e884. doi: 10.1016/S2352-3018(19)30264-4. Epub 2019 Oct 14.


The term HIV controller refers to the small proportion of individuals infected with HIV who can spontaneously control viraemia to maintain very low viral loads. One major unresolved question is whether HIV controllers should receive antiretroviral therapy, given that international guidelines recommend treatment for all individuals who are infected with HIV. Differences in the definitions of a controller (in terms of the viral-load cutoff and the duration of viral control) and contrasting reports on CD4 T-cell decline, chronic immune activation, the cardiovascular risk, and loss of viral control in controllers have prevented the development of a consensus view.

Publication types

  • Review

MeSH terms

  • CD4-Positive T-Lymphocytes / immunology*
  • Disease Progression
  • Guideline Adherence*
  • Guidelines as Topic
  • HIV Infections / immunology*
  • HIV Infections / virology
  • Humans
  • Lymphocyte Activation / physiology*
  • Viral Load / drug effects
  • Viral Load / physiology*
  • Viral Tropism / physiology
  • Viremia / immunology*