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

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: Between 1989 and 2023, 52 people with HIV-2 were included, primarily of West African origin (80.8%). Follow-up ranged from <1 to 32 years (median, 16 years). Seven participants were lost to follow-up (13.5.%), and 18 participants died (34.6%), 7 before ART availability due to AIDS. The remaining 40 participants were included in the detailed analysis. Thirteen were ECs with CD4+ T cells >350 cells/mm 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.