Functional cure of HIV-1 infection in an exceptional elite controller: a case report

Area of Science:

• Immunology
• Virology
• Genetics

Background:

• Identifying characteristics of functional cure for human immunodeficiency virus type 1 (HIV-1) infection is crucial.
• This study presents a unique case of functional cure in an elite controller.
• The case is compared with other elite controllers regarding immunological, virological, and clinical features.

Purpose of the Study:

• To describe a unique case of functional cure in an elite controller with HIV-1.
• To compare the immunological, virological, and clinical characteristics of this case with other elite controllers.
• To identify potential factors contributing to functional cure in HIV-1 infection.

Main Methods:

• A comprehensive analysis of virological and host features was performed on a case of functional cure, her partner, and cohorts of elite controllers and long-term elite controllers.
• Virological assays included reservoir quantification, quantitative viral outgrowth assay, and next-generation sequencing.
• Host assays encompassed HLA-I typing, host restriction factors, inflammatory markers, HIV-1 specific T-cell response, and immunophenotypic analysis.

Main Results:

• The case maintained undetectable plasma viral load and stable CD4 cell count without antiretroviral therapy for 22 years.
• HIV-1 DNA was undetectable in key CD4 cell populations, with all detected proviruses being defective.
• The case exhibited increased anti-HIV microRNAs/mRNAs, preserved T-cell homeostasis, low exhaustion markers, specific natural killer cell profiles, and decreased plasma inflammatory markers compared to controls.

Conclusions:

• Functional cure of HIV-1 infection is an uncommon yet achievable outcome.
• The findings encourage further research into therapeutic strategies to achieve functional cure in people with HIV-1.
• Unique immunological and virological profiles in elite controllers may offer insights into HIV-1 remission.