This is an open-label phase 1b clinical trial enrolling people living with HIV (PLWH) who are antiretroviral therapy (ART)-naïve or have not been on ART for \> 24 weeks. This study will enroll PLWH to assess the safety, tolerability, and antiviral effect of bispecific and long-acting bNAbs, alone and in combination. The study will be conducted as a single center study at National Institute for Medical Research-Mbeya Medical Research Center (NIMR-MMRC) in Mbeya, Tanzania. 20 PLWH will be sequentially enrolled into one of 5 arms, each arm comprised of 4 participants. Sequential enrollment will occur in the following order: * Arm 1 will receive standard daily oral ART. * Arm 2 will receive a single dose of 10E8.4/iMab 600mg intravenous injection (IV). * Arm 3 will receive a single dose of 10E8.4/iMab 600mg intramuscular injection (IM). * Arm 4 will receive a single dose of 10E8.4/iMab 1800mg IV. * Arm 5 will receive a single dose of combination therapy with both 10E8.4/iMab 1800mg IV and VRC07-523LS 1200mg IV.
Although global initiatives have made great strides in controlling the human immunodeficiency virus (HIV) pandemic, HIV and acquired immune deficiency syndrome (AIDS) continue to impact the lives and livelihoods of a significant portion of the population. In 2019, 38 million individuals were living with HIV and 690,000 died of AIDS-related causes. Despite extensive global efforts for disease control over the last 20 years, 1.7 million individuals contract HIV annually. Antiretroviral therapy (ART) reduces morbidity and mortality associated with HIV by suppressing viral replication but does not eradicate infection. There are barriers to universal ART use that include toxicities, costs, drug resistance, and the need for lifelong adherence. To overcome these barriers, HIV broadly neutralizing antibodies (bNAbs) represent a novel approach to HIV prevention and treatment. The primary endpoint of change in viral load will be assessed at day 14. Participants will then transition to Step 2, during which all participants will take standard daily oral ART and have viral load monitored through Step 2 week 48.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
20
ART is a combination of three or more drugs from different classes of antiretroviral medication.
10E8.4/iMab is an engineered bispecific antibody with two arms combined into a single molecule that exhibits synergistic enhancement of antiviral activity. 10E8.4/iMab will be administered IV at the 600mg or 1800mg dose or IM at 600mg dose to participants in Step 1 per the Schedule of Events (SOE) based on the arm the participant is assigned.
VRC07-523LS is an engineered variant of VRC01, a bNAb that targets the CD4 binding site of the HIV-1 envelope. VRC07-523LS will be administered IV at the 1200mg dose to participants in Step 1 per the SOE.
National Institute for Medical Research-Mbeya Medical Resarch Center
Mbeya, Tanzania
Number of Grade 3 or higher antibody-related reactogenicity and adverse events
Includes potentially life-threatening, or fatal events.
Time frame: Up to Week 48 in Step 2
Change in plasma HIV RNA from day 0 to day 14
Viral RNA copies/mL will be measured.
Time frame: Day 0 and Day 14 in Step 1
Proportion of participants with HIV RNA < 50 copies/mL at day 14
Percentage of participants will be calculated.
Time frame: Up to Day 14 in Step 1
Proportions of participants with HIV RNA <50 copies/mL
Percentage of participants will be calculated.
Time frame: Up to Week 48 in Step 2
Proportions of participants with HIV RNA < 200 copies/mL
Percentage of participants will be calculated.
Time frame: Up to Week 48 in Step 2
Proportions of participants with HIV RNA <1000 copies/mL
Percentage of participants will be calculated.
Time frame: Up to Week 48 in Step 2
Peripheral HIV RNA
Serum level of viral RNA (copies/mL) will be measured.
Time frame: Up to Week 48 in Step 2
Plasma level of 10E8.4/iMab
Serum level of 10E8.4/iMab (ug/mL) will be measured.
Time frame: Up to Week 48 in Step 2
Plasma level of VRC07-523LS
Serum level of VRC07-523LS (ug/mL) will be measured.
Time frame: Up to Week 48 in Step 2
CD4 receptor occupancy
The percentage of CD4 cells that bind to 10E8.4/iMab will be measured.
Time frame: Up to Week 48 in Step 2
HIV reservoir size
Will measure HIV DNA in copies/million cells.
Time frame: Up to Week 48 in Step 2
Neutralization sensitivity of 10E8.4/iMab
Half-maximal inhibitory concentration (IC50) will be measured.
Time frame: Up to Week 48 in Step 2
Neutralization sensitivity of VRC07-523LS
Half-maximal inhibitory concentration (IC50) will be measured.
Time frame: Up to Week 48 in Step 2
Presence of anti-bNAb antibodies
The anti-drug antibody titer in serum will be measured.
Time frame: Up to Week 48 in Step 2
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