Gabriela Turk, PhD*; Kyra Seiger, BSc*; Xiaodong Lian, PhD; Weiwei Sun, PhD; Elizabeth M. Parsons, BSc; Ce Gao, PhD;
Yelizaveta Rassadkina, BSc; Maria Laura Polo, PhD; Alejandro Czernikier, MSc; Yanina Ghiglione, PhD; Alejandra Vellicce, MD;
Joseph Varriale, MSc; Jun Lai, MSc; Yuko Yuki, DDM; Maureen Martin, MD; Ajantha Rhodes, BSc; Sharon R. Lewin, PhD;
Bruce D. Walker, MD; Mary Carrington, PhD; Robert Siliciano, MD; Janet Siliciano, PhD; Mathias Lichterfeld, MD, PhD†;
Natalia Laufer, MD, PhD†; and Xu G. Yu, MD, MSc†
Background: A sterilizing cure of HIV-1 infection has been
reported in 2 persons living with HIV-1 who underwent allogeneic
hematopoietic stem cell transplantations from donors who were
homozygous for the CCR5D32 gene polymorphism. However, this
has been considered elusive during natural infection.
Objective: To evaluate persistent HIV-1 reservoir cells in an
elite controller with undetectable HIV-1 viremia for more than
8 years in the absence of antiretroviral therapy.
Design: Detailed investigation of virologic and immunologic
characteristics.
Setting: Tertiary care centers in Buenos Aires, Argentina,
and Boston, Massachusetts.
Patient: A patient with HIV-1 infection and durable drug-
free suppression of HIV-1 replication.
Measurements: Analysis of genome-intact and replication-
competent HIV-1 using near-full-length individual proviral
sequencing and viral outgrowth assays, respectively; analysis of
HIV-1 plasma RNA by ultrasensitive HIV-1 viral load testing.
Results: No genome-intact HIV-1 proviruses were detected in
analysis of a total of 1.188 billion peripheral blood mononu-
clear cells and 503 million mononuclear cells from placental
tissues. Seven defective proviruses, some of them derived from
clonally expanded cells, were detected. A viral outgrowth assay
failed to retrieve replication-competent HIV-1 from 150 million
resting CD4+ T cells. No HIV-1 RNA was detected in 4.5 mL of
plasma.
Limitations: Absence of evidence for intact HIV-1 proviruses
in large numbers of cells is not evidence of absence of
intact HIV-1 proviruses. A sterilizing cure of HIV-1 can never
be empirically proved.
