Learning About HIV Viral Suppression: a Small Study

You have probably seen the recent news about the "Esperanza patient." This person has been able to clear any measurable HIV in their cells for more than 8 years in the absence of antiretroviral therapy (ART).^1,2

Controlling the virus without medications is not unheard of, but it is rare - it has been seen in less than 1 percent of people living with HIV. Recent study findings from the National Institutes of Health (NIH) shed light on how these "elite controllers" are able to control the virus. This may lead researchers to develop better treatments for HIV.^3-5

Viral supression in elite controllers

What is happening in the bodies of these elite controllers? The 2018 CHAMP study found 67 people (out of the 700 studied) that kept their viral load numbers low, even off ART. All had taken ART and then stopped while being closely monitored.⁶

Supression was not consistent over time

They found that about half of those 67 people managed to keep their viral load under 400 copies/mL most of the time for 2 years. About 1 in 5 lasted 5 years and 2 people were suppressed for more than 10 years. This ability to keep viral load low off meds was more common in people who had started treatment very early.⁶

But they were not suppressed all the time. All of them did have spikes in viral load over 1000 copies/mL, especially in the first couple of years.⁶

A major problem in finding a cure for HIV is that the virus can "hide" in cells, especially CD4 cells. The body’s immune system has trouble finding and getting rid of the virus there. Studies show that people with less HIV "hidden away" may be better able to suppress their viral load. It may be that early treatment helps prevent large numbers of the hidden virus to build up.^7,8

How did their immune systems suppress viral loads?

The recent NIH study looked at 2 people who were able to keep viral load low while off meds to learn how their bodies did it. Researchers found that their immune systems worked in very different ways to suppress the virus.^4,5

Extra CD8+ T cells and neutralizing antibodies

One person made extra CD8+ T cells, which can kill cells containing the virus. This person experienced ups and downs in their viral load for over 3 years before deciding to restart ART.

The second person, instead, had a lot of neutralizing antibodies to clear the virus. Antibodies are proteins that our body makes to protect us from infection. Having more of these neutralizing antibodies may allow a person to clear HIV more effectively. This person continued to have a low viral load for nearly 4 years.

How these finding inform HIV research

How does learning about these 2 people help us get closer to a cure for HIV? Knowing how the immune system works to clear HIV can help scientists design treatments.

For example, one of the vaccines being studied now creates neutralizing antibodies like the second study subject. The hope is that these antibodies will stop HIV from getting into cells in the first place.^9,10

At this time, ART is the most effective way to suppress HIV viral load. These drugs are an amazing product of science and have changed the course of HIV, but they can be hard at times - filling prescriptions, checking blood tests, taking the pills every day. Studies like this may help lead scientists to better therapies that will make treatment easier for people living with HIV.

Dr. Audrey Sheridan is a board-certified obstetrician-gynecologist (OB-GYN) and also a caretaker for her dad. Dr. Sheridan is inspired by people finding their way through life-changing medical situations with resilience and is interested in how we can increase our mental durability in the face of the unpredictable.