New HIV ‘functional cure’ case is not the final chapter, but creates more paths for cure research

We have a newly published case of a person who acquired HIV and is experiencing a “functional cure” without ever taking antiretroviral therapy. As usual, stories like this generate a lot of hype—but how much is actually warranted? Let’s dig in.

Highlighted Study Population and Methods

The authors describe the index case of a 48-year-old heterosexual woman of Indian descent living in Spain who was diagnosed with HIV-1 infection in 2002 after sexual exposure from an HIV-positive male partner.

The researchers conducted comparative analyses between the woman and:

• Her partner: A 58-year-old man of Indian descent with HIV-1 and history of Pneumocystis jiroveci pneumonia.

• Cohort 1 (n=9): Elite controllers—individuals with at least three consecutive undetectable HIV viral loads over ≥12 months without antiretroviral therapy (ART).

• Cohort 2 (n=12): Long-term elite controllers—elite controllers maintaining immunological and virological control for ≥10 years.

• Controls not living with HIV.

Analyses included:

• Virological: Reservoir quantification, quantitative viral outgrowth assay to assess replication-competent virus, and next-generation sequencing of HIV RNA and DNA.

• Host immunological: HLA-I typing, measurement of host restriction factors, plasma inflammatory marker profiling, HIV-specific T-cell responses, and immunophenotyping of T cells, monocytes, and NK cells.

Key Findings

The woman maintained undetectable plasma viral load and stable CD4 counts for 22 years without ART, without HIV-related symptoms. The study manuscript states that:

• In both resting memory CD4 and peripheral T follicular helper cells, HIV-1 DNA was undetectable.

• Full-length proviral sequencing: 0.82 HIV genomes per million CD4 cells — all defective; no intact, replication-competent virus detected.

Compared with both elite controller cohorts, the manuscript states that the woman had:

• Increased expression of several microRNAs and mRNAs with possible anti-HIV activity.

• Preservation of T-cell homoeostasis with low expression of markers of cell exhaustion, apoptosis, and senescence.

• Natural killer cells with low inhibitory receptor expression and higher expression of regulatory natural killer cells.

• Decreased levels of inflammatory biomarkers.

Read an expert analysis from Benjamin Young, M.D., Ph.D. at TheBodyPro.