Case of functional cure reported in an elite controller after 22 years without ART

23 November 2025. Related: Journal scan, Cure-related research.

Simon Collins, HIV i-Base

A third report of functional cure in an elite controller have been reported in Lancet HIV, in this case of a 48 year-old Indian woman living in Spain who was diagnosed HIV positive in 2002. [1]

Longitudinal virologic and immunologic results over the next 22 years are reported, together with comparisons to small cohorts of elite controllers (n=9) and HIV negative controls (n=12). Viral load remained undetectable and CD4 count remained stable without ART over this time.

HIV-1 DNA was undetectable in resting memory CD4 cells and peripheral T follicular helper cells showing no evidence on ongoing replication.

Although HIV genetic material was present at very low levels of 0.8 genomes/million CD4 cells, all were defective with large deletions that meant they were no longer able to replicate.

The previous cases of functional cure in elite controllers were Loreen Willenberg and the Esperanza Patient after maintaining undetectable viral load for 28 and 8 years respectively. [3, 4]

comment

These extremely rare cases are important to report and to understand the natural diversity of responses to HIV.

In a talk at the BHIVA Spring conference last year, Asier Sáez-Cirión from the Pasteur Institute estimated that there are more than 1000 cases reported of natural HIV controllers who remain undetectable for up to 30 years without ART and more than 100 post-treatment controllers with previously detectable viral load who have remained undetectable for up to 22 years after discontinuing treatment. [2]

References

1. Benito José M et al. Functional cure of HIV-1 infection in an exceptional elite controller: a case report. Lancet HIV. (04 November 2025).
   https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(25)00233-4/fulltext
2. Asier S-C. HIV Cure: strategies, perspectives. BHIVA Spring Conference Programme 23rd – 25th April 2025, Brighton.
   https://bhiva.org/event/bhiva-spring-conference-2025
3. Jefferys R. New insights into elite control of HIV and a possible case of virus clearance. (28 August 2020).
   https://i-base.info/htb/38951
4. Jefferys R. The Esperanza Patient – Argentinian Woman’s Immune System May Have Cleared All Intact HIV. (November 2021).
   https://www.treatmentactiongroup.org/cure/media-monitor/story-the-esperanza-patient-argentinian-womans-immune-system-may-have-cleared-all-intact-hiv/