Persistent viral control status is associated with enhanced innate immune responses in people living with HIV-1

The mechanisms mediating elite and persistent HIV control in people living with HIV (PLHIV) are only partially understood and largely attributed to adaptive T cell responses, but whether innate immunity also contributes remains unclear. Using samples from the 2000HIV study, we examined the transcriptional and functional profiles of monocytes from spontaneous HIV controllers and normal progressors on long-term antiretroviral therapy. HIV controllers displayed enhanced cytokine production after bacterial and viral stimulation, alongside antiviral and interferon-inducible transcriptional signatures and reduced inflammatory gene expression. Persistent controllers further showed increased capacity for trained immunity, with H3K4me3 profiling indicating epigenetic priming of innate immune genes, independent of known genetic determinants. Remarkably, relatives of persistent controllers also exhibited stronger innate and trained immune responses than relatives of normal progressors. These findings suggest that robust innate immunity, particularly monocyte function, may precede infection and contribute to sustained HIV control, offering new avenues for therapies that induce similar innate antiviral responses.