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Insights to a Cure: Unique Controller Phenotypes in the Rotterdam HIV-2 Cohort

Year: 2025

Type: article

Abstract: Background: HIV-2, although less common than HIV-1, exhibits a higher proportion of elite controllers (ECs), who can suppress HIV without antiretroviral therapy (ART), a phenomenon rarely observed in HIV-1. Studying ECs could yield insights into viral control mechanisms and potentially lead to a cure. Methods: We retrospectively characterized a cohort of people with HIV-2 who received care at the Erasmus University Medical Center, Rotterdam, Netherlands. The aim was to identify categories of ECs based on plasma viral loads, CD4+ T-cell count, and responses to ART. Results: without symptoms of HIV despite undetectable viral loads (nonviremic progressors). Three individuals demonstrated EC status for at least 5 years but lost viral and immunologic control. Nineteen participants exhibited a classical phenotype of viremic progression. Five participants had HIV-1 and HIV-2. Finally, 1 participant had a unique phenotype with loss of control with an unexplained rebound in viremia, followed by resuppression without ART for >10 years (recontroller). Conclusions: These data highlight relevant trajectories among ECs. Understanding the underlying mechanisms can inform decisions on treatment and contribute to finding a cure for all people with HIV.

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofaf336