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Spontaneous virologic suppression in HIV controllers is independent of delayed-type hypersensitivity test responsiveness

Jason F Okulicz12*, Greg A Grandits3, Matthew J Dolan4, Vincent C Marconi5, Glenn Wortmann16 and Michael L Landrum12

Author Affiliations

1 Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

2 San Antonio Military Medical Center, Infectious Disease Service, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA

3 Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA

4 Henry M. Jackson Foundation, Lackland AFB, TX, USA

5 Emory University School of Medicine, Atlanta, GA, USA

6 Infectious Disease Service, Walter Reed National Military Medical Center, Bethesda, MD, USA

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AIDS Research and Therapy 2012, 9:10  doi:10.1186/1742-6405-9-10

Published: 2 April 2012



Delayed-type hypersensitivity (DTH) testing, an in vivo assessment of cell-mediated immunity, is a predictor of HIV disease progression beyond CD4 cell count. We investigated whether preserved DTH responsiveness was characteristic of HIV controllers compared to non-controllers and individuals on suppressive HAART.


DTH testing consisted of ≥ 3 recall antigens applied approximately every 6 months. DTH responses were classified by the number of positive skin tests: anergic (0), partial anergic (1), or non-anergic (≥ 2). HIV controllers were compared to treatment naïve non-controllers (n = 3822) and a subgroup of non-controllers with VL < 400 copies/mL on their initial HAART regimen (n = 491). The proportion of non-anergic results at first DTH testing was similar for HIV controllers compared to non-controllers (81.9% vs. 77.6%; P = 0.22), but tended to be greater in HIV controllers compared to the HAART subgroup (81.9% vs. 74.5%; P = 0.07). Complete anergy was observed in 14 (10.1%) HIV controllers with CD4 counts ≥ 400 cells/uL. For longitudinal testing, the average percentage of non-anergic DTH determinations per participant was higher in HIV controllers compared to non-controllers (81.2 ± 31.9% vs. 70.7 ± 36.8%; P = 0.0002), however this difference was eliminated with stratification by CD4 count: 200-399 (83.4 ± 35.6% vs. 71.9 ± 40.9%; P = 0.15) and > 400 cells/uL (81.2 ± 31.5% vs. 80.4 ± 32.7%; P = 0.76).


Spontaneous virologic control was not associated with DTH responsiveness, and several HIV controllers were anergic despite having elevated CD4 counts. These findings suggest that cellular immunity assessed by DTH is not a principal factor contributing to spontaneous virologic suppression in HIV controllers.

HIV; Elite controllers; HIV controllers; Delayed-type hypersensitivity test; HAART