Led by scientists at the Ragon Institute of Massachusetts General Hospital, MIT, and Harvard, the investigation examined more than 1.19 billion blood cells and 500 million tissue cells from a 30-year-old woman in Argentina, dubbed “the Esperanza patient.” Analysis of this massive numbers of cells revealed that the woman had been infected before, but scientists did not discover any intact human immunodeficiency virus (HIV) capable of replicating in the patient. Diagnosed with HIV in 2013, the subject only received antiretroviral treatment for six months when she became pregnant in 2019. After she gave birth to an HIV-negative child in March 2020, she stopped therapy. Researchers concluded that patient may have naturally achieved what is called a “sterilizing cure of HIV-1 infection.” “These observations raise the possibility that a sterilizing cure may be an extremely rare but possible outcome of HIV-1 infection,” wrote the study authors. The Esperanza patient is known as an “elite controller.” These individuals have immune systems that are able to suppress HIV without the need for antiretroviral therapy (ART). The Ragon Institute writes on its website that these individuals still have viral reservoirs that can produce more HIV virus, but they also have a type of immune cell called a killer T cell that keeps the virus suppressed without the need for medication. Xu Yu, MD, and Mathias Lichterfeld, MD, PhD, who were among the authors on this latest study, had reported last year on the case of the “San Francisco patient,” Loreen Willenberg, who was the first person believed to have naturally cleared her HIV infection. The Foundation for AIDS Research, amfAR, called their research on elite controllers “groundbreaking.” “It showed that the virus in elite controllers is more likely to be found in “gene deserts,” regions where the HIV remains tightly locked down, unable to replicate, and that in Willenberg’s case, known as extraordinary elite control (EEC), no intact viruses were found at all,” writes amfAR. The same was the case regarding the Esperanza patient’s spontaneous cure. “These findings, especially with the identification of a second case, indicate there may be an actionable path to a sterilizing cure for people who are not able to do this on their own,” said Dr. Yu, on the Ragon Institute website. She added that these results suggest the possibility that other people with HIV may have also achieved a sterilizing cure, and further study of immune mechanisms in these two “exceptional controllers” may lead to therapies that can train the immune systems of other HIV patients to replicate the response.
