To the Editor: People living with HIV (PLWH) who are able to maintain suppressed viral load (VL) for years in the absence of antiretroviral therapy (ART) are known as elite controllers (ECs). ECs represent a heterogeneous population in terms of virological, immunological, and clinical outcomes, and approximately 25% of ECs lose viral control overtime. The study of the mechanisms leading to the loss of viral control in ECs is crucial for the identification of differential markers for the design of novel eradication and immunotherapeutic strategies.

Previously, we identified virological and immunological factors involved in the spontaneous loss of viral control, 1 and we also demonstrated that proteomics and metabolomics are powerful tools to identify potential biomarkers and therapeutic targets in ECs. 2, 3 Additionally, genome-wide associations and transcriptome analyses have also been described for ECs and compared to other phenotypes of PLWH, 4, 5 in particular the study of specific microRNA (miRNA) expression profiles. 5 miRNAs play vital roles in development, apoptosis, and oncogenesis by interfering with gene expression at the post-transcriptional level. 6 In HIV/AIDS scenario, the most relevant feature is that some miRNAs can modulate HIV replication by directly targeting HIV RNA or targeting messenger RNA (mRNA) of cell factors necessary for HIV replication. 7 Our study conducted in 18 ECs (Figure S1, Table S1), 12 individuals who experienced a loss of spontaneous viral HIV-1 control (transient controllers, TCs) and six ECs who persistently maintained viral control during the same follow-up period (persistent controllers, PCs), showed an upregulated plasma miRNA profile in TCs before and after the loss of viral control.