The purpose of this study is to learn whether having the AMP Study antibody (called VRC01) in a person's body might help their immune system control HIV better, even without HIV medication called antiretroviral therapy or ART, if they get HIV. This study will evaluate the viral and immune system responses in an Analytical Treatment Interruption (ATI), in participants who received VRC01 or placebo and got HIV while enrolled in HVTN 703/HPTN 081 (NCT02568215). Participants in this study will stop taking their HIV medication. They will stay off HIV medication unless and until the HIV levels in their blood show that their immune system is unable to control the HIV or they meet other ART re-start criteria as noted in section "Detailed Description". While they are not taking HIV medication, their HIV levels will be tested frequently, and their health will be monitored closely. This is called an analytical treatment interruption, or an ATI. An ATI is an experimental procedure that is only used in carefully monitored research.
The purpose of this study is to evaluate immunologic and virologic responses in an Analytical Treatment Interruption (ATI), in participants who received VRC01 or placebo and got HIV while enrolled in the HVTN 703/HPTN 081 Antibody-Mediated Prevention (AMP) Study (NCT02568215). ATI begins with the cessation of ART on Schedule 1 (Monitoring ATI). Participants on Schedule 1 will attend study visits every week for the first 8 weeks and at least every 2 weeks for the next 16 weeks. After that, participants will attend study visits once a month for the next 6 months, if their body is controlling their HIV without ART. Participants on Schedule 1 for more than a year will have visits every 3 months. For participants on Schedule 1 (Monitoring ATI), a confirmed VL ≥ 200 copies/mL will trigger transition to Schedule 2 (ATI monitoring with viremia). Participants on Schedule 2 will attend study visits every week for the first 8 weeks and at least every 2 weeks for the next 28 weeks. After that, participants will attend study visits once a month for the next 4 months, if their body is controlling their HIV without ART. Participants on Schedule 2 for more than a year will have visits every 3 months. For participants on Schedule 1 (Monitoring ATI), any of the following non-virologic criteria will trigger re-initiation of ART and transition to Schedule 3 (Follow-up on ART): confirmed CD4+ T-cell count \< 350 cells/mm3, any HIV-related syndrome, pregnancy or breastfeeding, or ART re-initiation requested by participant or if deemed medically necessary by primary HIV provider or clinical research site Investigator of Record. Participants on Schedule 3 will attend study visits every 2 weeks for the first 12 weeks, once a month for the next 16 weeks, and on 2 occasions 3 months apart for the next 24 weeks. For participants on Schedule 2 (ATI monitoring with viremia), the following virologic criteria will trigger re-initiation of ART and transition to Schedule 3 (Follow-up on ART): viral load remains ≥ 1,000 copies/mL for ≥ 4 consecutive weeks AND viral load has not dropped 0.5 log from the previous week (Week 0 - Week 24), confirmed viral load ≥ 200 copies/mL (after Week 24). Or, the following non-virologic criteria will trigger re-initiation of ART and transition from Schedule 2 (ATI monitoring with viremia) to Schedule 3 (Follow-up on ART): confirmed CD4+ T-cell count \< 350 cells/mm3, any HIV-related syndrome, pregnancy or breastfeeding, or ART re-initiation requested by participant or if deemed medically necessary by primary HIV provider or clinical research site Investigator of Record. Study duration is potentially indefinite for participants maintaining extended viral control during ATI. Study duration for most participants is expected to be 13-18 months. The maximum anticipated duration for any participant is expected to be approximately 2 1/2 to 3 years. Visits may include medical history review, physical exam, HIV testing, other STI testing (blood, urine, and cervical/vaginal swab collection), blood draws, pregnancy testing for participants that can become pregnant, HIV transmission risk reduction counseling, and interviews/questionnaires.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
OTHER
Masking
NONE
Enrollment
13
Participants will stop taking their HIV medication and will stay off HIV medication unless and until the HIV levels in their blood show that their immune system is not controlling their HIV or they meet other ART re-start criteria as noted in section "Detailed Description".
Gaborone CRS
Gaborone, Botswana
Blantyre CRS
Blantyre, Malawi
Malawi CRS
Lilongwe, Malawi
CAPRISA eThekwini CRS
Durban, South Africa
Vulindlela CRS
Durban, South Africa
Kliptown Soweto CRS
Johannesburg, South Africa
Ward 21 CRS
Johannesburg, South Africa
Rustenburg CRS
Rustenburg, South Africa
Milton Park CRS
Harare, Zimbabwe
Seke South CRS
Harare, Zimbabwe
...and 1 more locations
Time to Meeting Criteria for ART Re-initiation
From ART Re-Initiation Criteria form, calculated median and range of weeks of ATI meeting ART re-initiation criteria by HVTN 703/HPTN 081 treatment assignment. Note that participants with evidence of ARV use during ATI schedule are excluded
Time frame: Measured through participant's last visit on Schedule 1 or 2, up to 27 months.
Frequency of Sustained Post-treatment HIV Control, Defined as ≥ 24 Weeks Off ART Without Meeting ART Re-initiation Criteria
From ART Re-Initiation Criteria form, counts number of participants with ≥ 24 weeks of ART without meeting ART re-initiation criteria by HVTN 703/HPTN 081 treatment assignment. Note that participants with evidence of ARV use in ATI monitoring schedule are excluded from the analysis
Time frame: Measured at week 24 of schedule 1- monitoring ATI
Percentage of Participants Who Experience Adverse Events (AEs)
Graded according to the Division of AIDS Table for Grading the Severity of Adult and Pediatric Adverse Events, Corrected Version 2.1, July 2017
Time frame: Measured through participant's last study visit, up to 39 months.
Number of Participants Reporting Serious Adverse Events (SAEs)
Graded according to the Division of AIDS (DAIDS) Table for Grading the Severity of Adult and Pediatric Adverse Events, Corrected Version 2.1, July 2017
Time frame: Measured through participant's last study visit, up to 39 months.
Percent of Participants Who Discontinue ATI
Tabulated by reason and HVTN 703/HPTN 081 treatment group. Note that 1. participants (N= 2) with evidence of ARV use during ATI schedule are excluded; 2. Participants may meet more than one ART re-initiation criterion.
Time frame: Measured through participant's last visit on Schedule 1 or 2, up to 27 months
Number of Local Laboratory Values Meeting Grade 2 AE Criteria or Above
The number (percentage) of participants with lab grade \> 1 for alanine aminotransferase (ALT), Estimated Glomerular Filtration Rate (eFGR), Absolute Neutrophil Count, Direct Bilirubin, Hemoglobin, Platelets was summarized by arm. Only measurements with at least 1 record of grade 2 AE or above were shown in the table.
Time frame: Measured through participant's last study visit, up to 39 months
Cumulative Incidence of Participants With First Viral Load ≥ 200 Copies/mL at Week 8, 16, and 24 of Schedule 1: Monitoring ATI
The number (percentage) of participants with first viral load \>= 200 by Schedule 1 week 8, 16, and 24. 2 Participants from VRC01 10mg/kg group with evidence of ARV use during ATI schedule are excluded. Given only 3 VRC01 10mg/kg participants followed ATI schedule, VRC01 treatment arms are grouped in this analysis.
Time frame: Measured for participants undergoing ATI at week 8, 16, and 24
Response Rate of HIV-specific CD4+ and CD8+ T-cells
The four entries in each table were the number of cells positive for IFN-γ and/or IL-2 for both the stimulated and the negative control data. If both negative control replicates were included, then the average number of total cells and the average number of positive cells were used. A one-sided Fisher's exact test was applied to the table, testing whether the number of cytokine-producing cells for the stimulated data was equal to that for the negative control data. Since multiple individual tests (for each peptide pool) were conducted simultaneously, a multiplicity adjustment was made to the two individual peptide pool p-values considered, using the Bonferroni-Holm adjustment method. If the adjusted p-value for a peptide pool was ≤ 0.00001, the response to the peptide pool for the T-cell subset was considered positive. If at least one peptide pool for a specific HIV-1 protein was positive, then the overall response to the protein was considered positive.
Time frame: Measured through participant's last study visit, up to 39 months
Magnitude of HIV-specific CD4+ and CD8+ T-cells
PBMC samples were stimulated with synthetic peptide pools or left unstimulated as a negative control. For each sample, T-cell subset, and peptide pool, response magnitude is % cells expressing cytokines (IFNy and/or IL-2) after peptide stimulation minus % cells expressing markers after no stimulation.
Time frame: Measured through participant's last study visit, up to 39 months
Magnitude of Neutralizing Antibodies (nAb) Responses Against Autologous and Global HIV Panel Isolates
NAb against HIV-1 were measured as a function of reductions in Tat-regulated luciferase (Luc) reporter gene expression in TZM-bl cells. Samples were processed using ART-Dex method to remove antiretrovirals in the specimens. An ART-resistant backbone was utilized to produce the viruses used for the study to further minimize potential virus inhibition by residual antiretrovirals. A titer was defined as the serum dilution that reduced relative luminescence units (RLUs) by 50% relative to the RLUs in virus control wells (cells + virus only) after subtraction of background RLU (cells only). Net titer was then calculated by subtracting the MLV values, where the titer was set to 25 if it is less then MLV titer. For T/F and rebound autologous isolates, if participants with multiple isolates detected at each dilution and timepoints, geometric means titer was calculated.
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Time frame: Measured at schedule 1 visit 4 (baseline, ATI initiation), schedule 3 visits 80 (ART re-initiation), 86 (12 weeks post ART re-initiation), and 89 (24 weeks post ART re-initiation)
Non-neutralizing, FcγR-mediated Antibody Effector Functions Measured by ADCC
Measured by ADCC
Time frame: Measured through participant's last study visit, on average 15 months
Non-neutralizing, FcγR-mediated Antibody Effector Functions Measured by ADCP
Measured by ADCP
Time frame: Measured through participant's last study visit, on average 15 months
Non-neutralizing, FcγR-mediated Antibody Effector Functions Measured by Virion Capture
Measured by virion capture
Time frame: Measured through participant's last study visit, on average 15 months
Frequency of Dendritic Cell Activation and Maturation Markers
Peripheral blood mononuclear cells (PBMC) obtained as specified in AMP ATI protocols were used to examine the frequency of dendritic cells (DC) using a previously established DC high parameter flow cytometry panel that has been slightly modified to include Ki67, a marker of activation. This phenotyping was performed using PBMC that were thawed for the ICS assay for samples with sufficient cells for both ICS and phenotyping.
Time frame: Measured through participant's last study visit, up to 39 months
Frequency of T- and B-cell Activation and Exhaustion Markers
Measured by flow cytometry or other cell phenotyping assays
Time frame: Measured through participant's last study visit, up to 39 months
Frequency of CD4+ T Cells Carrying Intact and/or Total Pro-viral HIV DNA, Replication Competent Virus, and/or Cell-associated HIV RNA
Measured by Intact Proviral DNA Assay (IPDA), Tat/rev Induced Limiting Dilution Assay (TILDA), assays detecting replication-competent virus-bearing cells, and/or measures of total proviral DNA. Cell-associated HIV-RNA may be quantitated as a measure of the transcriptionally active reservoir.
Time frame: Measured through participant's last study visit, up to 39 months