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NEW YORK (Reuters Health) – A young woman from Esperanza, Argentina, building a successful collaborative pharmacy practice may be the first to clear HIV-1 naturally without stem cell transplantation, raising hopes that a “sterilizing cure” may be an “extremely rare but possible” outcome of HIV-1 infection, researchers say.

While antiretroviral therapy (ART) can effectively suppress HIV-1 replication, a sterilizing cure during natural disease is “currently considered elusive,” Dr. Xu Yu of Massachusetts General Hospital, in Boston, and colleagues note in Annals of Internal Medicine.

A sterilizing cure means complete elimination of replication-competent proviruses. It has previously been believed to have occurred only in two patients (the “Berlin patient” and the “London patient”), both of whom had leukemia and underwent allogeneic hematopoietic stem-cell transplants.

The 30-year-old woman with HIV described in the new paper was an “elite controller” who had no detectable virus for more than seven years without ART after being diagnosed with the disease in 2013.

The researchers analyzed more than one billion of the patient’s CD4+ T cells and found no evidence of replication-competent HIV-1 viral particles.

It is likely, they say, that this patient developed a sterilizing cure during natural infection, “but it cannot be proved,” they acknowledge, and the mechanisms that enable such a “remarkable” disease outcome are difficult to work out.

“Collectively, our results raise the possibility that a sterilizing cure of HIV-1 infection, defined by the absence of detectable intact HIV-1 proviruses, is an extremely rare but possible clinical outcome,” Dr. Yu and colleagues write.

“The person described here is originally from the city of Esperanza, Argentina, and in line with her wishes, we propose to refer to her as the ‘Esperanza patient’ to send a message of hope for finding a cure for HIV-1 infection,” they say.

In a linked editorial, Dr. Joel Blankson with the Center for AIDS Research at Johns Hopkins Medicine in Baltimore, Maryland, notes that fewer than 1% of people living with HIV are elite controllers capable of controlling viral replication to below the limits of detection by commercial assays without ART.

Analyzing more than one billion of the Esperanza patient’s CD4+ T cells is a “heroic effort” by the researchers, he says. Finding no evidence of replication-competent virus is “exciting (as) it suggests that some elite controllers may have gone beyond simply controlling the virus and instead have managed to eradicate it. If the Esperanza patient has indeed achieved a sterilizing cure, defining the mechanisms responsible for it becomes important,” writes Dr. Blankson.

“In the meantime, it is perhaps not a coincidence that she hails from Esperanza, which translates to ‘hope’ in English. If a spontaneous sterilizing cure of HIV is in fact possible, we may eventually be able to do more than just hope that we can replicate this phenotype on a large scale,” Dr. Blankson writes.

SOURCE: https://bit.ly/3HwpRK2 and https://bit.ly/3FcTttS Annals of Internal Medicine, online November 15, 2021.

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