Researchers from the Ragon Institute of Massachusetts General Hospital (MGH), Harvard and MIT and colleagues have identified a second patient who has been able to eliminate the HIV genome from their body without medication, suggesting it may be possible to train the body’s immune system to permanently eliminate the elusive virus.

Here are five things to know about their findings, which were recently published in the Annals of Internal Medicine:

During a typical HIV infection, the virus creates a viral reservoir by placing copies of its genome into cell DNA, thus allowing it to evade anti-HIV medication and the body’s natural immune defenses.

Xu Yu, MD, a principal investigator at the Ragon and physician-investigator at Massachusetts General Hospital, has been investigating this process in diverse populations of HIV patients.

Most HIV patients need to take daily antiviral medication to prevent these viral genomes from producing more copies of the virus. While worldwide efforts have been made to identify infected individuals and provide them with antiviral treatment, there are continued challenges related to medication access and adherence, particularly in countries with limited resources.

There are a small subset of individuals (approximately 1% of all HIV patients) known as elite controllers, who are able to control HIV infection without medication.

Nearly all of these elite controllers still have the viral genome within their cells but are able to stop the virus from replicating via a subset of immune cells known as killer T cells.

In 2020, Yu and colleagues identified the first individual, known as the San Francisco patient, who not only was able to control the virus without medication, but also had no intact HIV genome in any of the billions of blood cells and millions of tissue cells that the researchers sequenced. This was the first known instance of a “sterilizing cure” for HIV outside of a stem cell transplant.

In their latest study, Yu and colleagues identify a second individual, known as the Esperanza patient, who was also able to achieve a sterilizing cure for HIV. The researchers sequenced over 1.19 billion blood cells and 500 million tissue cells from the patient without finding any intact HIV genome.

The identification of these two patients suggests that a sterilizing cure is a possible—though incredibly rare—outcome of HIV infection, and that this process may be driven by a specific killer T cell response common to both patients. 

If researchers can understand this process, they may be able to develop vaccines that can teach the immune systems of HIV patients to mimic this response, which could potentially eliminate the need for daily antiretroviral treatment.

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Research at Massachusetts General Hospital is interwoven through more than 30 different departments, centers and institutes. Our research includes fundamental, lab-based science; clinical trials to test new drugs, devices and diagnostic tools; and community and population-based research to improve health outcomes across populations and eliminate disparities in care.
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