By Katie Willingham
The US HIV Cure Research Academy took place April 22 – 24, 2026, in Durham, North Carolina. This year's academy welcomed more than 30 talented participants working in the HIV field and interested in building knowledge of HIV cure science and skills in translation. The selected fellows had a unique opportunity to interact with leading researchers and advocates over 2.5 days of intensive training, networking opportunities, and hands-on experience. Read on for perspectives on the meeting from one of the two members of The Well Project's community advisory board that attended as fellows.
Jake Robinson, PhD, of the University of Pennsylvania presented on HIV controllers on our second day in Durham at the HIV Cure Research Academy. I not only enjoyed his presentation; I'm grateful to have met him. He's not only a brilliant doctor but he's also a very sweet and kindhearted man.
Have you ever wondered how some people can contract HIV and not need medication? Did you know that there are different kinds of controllers? Wait, what's a controller? A controller is someone who, for whatever reason, doesn't need medication to control their HIV viral load. A controller sometimes needs medication at first, but after treatment is paused (medication is only paused for studies and is not normal practice; this is called treatment interruption), the body is able to control the virus and keep a low viral load or have none at all. Or there are what's called elite controllers who never need any medication at all. Either way, whether with the assistance of medicine or not, controllers have HIV's number and can suppress it. In this presentation, Dr. Robinson talks about controllers and what we're learning about them.
Before we get into the weeds, let's begin with some important vocabulary that might be helpful for you:
Plasma viremia: amount of cell-free virus in the blood
Treatment interruption: stopping antiretroviral therapy to study outcomes
Autologous antibodies: your own antibodies
Setpoint: steady state of the viral load after its peak
Reservoir: integrated virus in cells in the body
Rebound: when the virus begins to return in the blood after ART (antiretroviral therapy) is paused
Time to rebound: the amount of time to detectable viral load after treatment is paused
Viremia/Viremic: the presence of virus in the blood.
Proviral: integrated virus in the cells.
So now you know what a controller is and what control looks like. That's when the body can produce a sufficient and strong enough immune response to suppress viral replication and spread in the body without medication. Sounds amazing doesn't it? How does this happen? We're still learning; no one yet knows how some people's immune response can control the virus without meds while most can't.
What is an elite controller? Elite controllers are a very rare subset of individuals able to maintain undetectable levels of plasma viremia (viral load) in the absence of ART and are considered outliers of natural HIV disease progression. Less than one percent of the population of people living with HIV are considered elite controllers, but of that population women are fourfold more likely to be controllers than men. Isn't that amazing? We're learning more also about the difference between male and female viremia and their immune responses; for more about that, please read my other post about gender differences: Considerations of Sex and Gender: A Recap from the 2nd US HIV Cure Research Academy
Viral factors that doctors are considering pertaining to elite controllers include the theory that their virus could be defective. There are stunted or "wimpy" viruses with what are known as nef and vpr defects, but elite controllers show no evidence of large deletions (meaning there's no virus that is dying and flushing out of the body), no hypermutations (meaning the virus isn't changing), or any known attenuated mutations (meaning the virus isn't mutating into a weakened version of itself). Is it possible for elite controllers to temporarily or permanently lose control of their viral load and have a measurable amount of viral load? We don't know, but I guess that means that no one has yet so far.
Something else that doctors are thinking about is the size, diversity, and location of reservoirs. There is extremely small and/or undetectable HIV DNA in billions of cells in the body. After more than 20 years of control, elite controllers show extremely low cellular HIV DNA, RNA, and proviral diversity.
It excites me to learn about reservoirs, because in my mind reservoirs are the last holdup. When the virus has been controlled or killed in the body small amounts of it can remain dormant in reservoirs. If we could learn how to eliminate the dormant virus from reservoirs that would be an effectual cure, wouldn't it?
We might not have a cure yet for the masses, but the science behind cure research is getting really exciting; we're getting so close. I truly believe that with proper funding and government cooperation we could end this disease in our lifetime – and that's where science gets political.
More from The Well Project on the 2nd US HIV Cure Research Academy
- Considerations of Sex and Gender: A Recap from the 2nd US HIV Cure Research Academy by Katie Willingham
- The Cure Research Academy by KatieAdsila on A Girl Like Me
- HIV Cure Academy - a poem by KatieAdsila on A Girl Like Me
- Learning Cure Science While Life Keeps Life-ing: A Recap from the 2nd US HIV Cure Research Academy by Robin Barkins
- South African Child Virtually Cured of HIV: A Case Study from the 2nd US HIV Cure Research Academy by Katie Willingham
