Antiretroviral therapy (ART) has significantly extended the life expectancy of people living with HIV-1 (PLWH), but it does not cure the infection. Broadly neutralizing antibodies (bNAbs), such as 3BNC117 and 10-1074, not only neutralize circulating virus but also engage the immune system to enhance HIV-1-specific CD8+ T cell responses and stimulate autologous neutralizing antibody production. In some individuals who discontinue ART, bNAb treatment resulted in long-term post-treatment control. However, a major obstacle to immunotherapeutic strategies in PLWH is the immune dysfunction that persists despite long-term suppressive ART. One contributing factor is the immune checkpoint receptor programmed death-1 (PD-1), which is expressed on T cells and suppresses their function when engaged by its ligands. Blocking PD-1 with monoclonal antibodies (mAbs) can reverse T cell exhaustion, a strategy that has resulted in extraordinary increases in survival and cure in cancer treatment and in ex vivo and animal studies of HIV. These findings support the rationale for incorporating PD-1 inhibition in HIV cure strategies. Low-dose nivolumab, an anti-PD-1 mAb, has been shown to be safe in clinical trials. The hypothesis is that combining a single low-dose of nivolumab with long-acting bNAbs (3BNC117-LS and 10-1074-LS) during an analytical treatment interruption (ATI) will reduce T cell exhaustion and boost HIV-1-specific immune responses, as a novel strategy to induce sustained virological control without ART even after the bNAbs have been cleared from the body.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
90
bNAb; 30 mg/kg
bNAb; 10 mg/kg
Anti-PD-1a; low dose 1.0 mg/kg
Saline
Time from the day of stopping ART to the day of meeting criteria for loss of immunological control of HIV-1 (defined below)
Loss of immunological control of HIV-1 is defined as one or more of the following three criteria: * Six weeks of consecutive plasma HIV-1 RNA \>1,000 copies/mL or confirmed \>100,000 copies/mL * Confirmed (on two consecutive measurements) CD4+ T cell count \<350 cells/mm3 * Participant's request or if the ATI in the opinion of the Sponsor or Investigator poses an unacceptable risk to the participant
Time frame: 60 weeks
The safety and tolerability of the Investigational Medicinal Products (IMPs)
Frequency and severity of adverse events (AEs), serious AEs (SAEs). Relationship to study drug and severity will be graded according to Division of AIDS (DAIDS) Grading Table, v2.1
Time frame: Adverse events will be recorded from signing of the informed consent form and until end of study week 60 or visit 50 following restart of ART, whichever comes first.
The frequency of post-interventional immunological control of HIV-1
Durable immunological control of HIV-1 as defined in the primary outcome
Time frame: At week 24, 36, 48 and 60
The effect of the IMPs on HIV-1-specific T cells responses before, during and after the ATI
Changes in HIV-1-specific T cell responses as measured by flow cytometry, T cell Elispot, and lymphocyte proliferation.
Time frame: From baseline to weeks 8, 12, 16, 24 and 60 or ART-restart, whichever comes first
The effect of the IMPs on the intact HIV-1 reservoir before, during and after the ATI
Changes in the levels of intact proviral HIV-1 DNA per million CD4+ T cells as measured by PCR-based techniques
Time frame: From baseline to weeks 24 and 60 or ART-restart, whichever comes first
The effect of the IMPs on the immune cell phenotype, activation and exhaustion
Changes in the distribution of immune cell subsets, activation and exhaustion markers as measured by flow cytometry
Time frame: From baseline to weeks 8, 16, 24 and 60 or ART-restart, whichever comes first
The effect of autologous antibodies on post-interventional immunological control of HIV-1
Changes in autologous neutralizing antibody titers from baseline as determined by ex vivo neutralization assays
Time frame: Time from the day of stopping ART to weeks 24 and 60 or day of restarting ART, whichever comes first
bNAb sensitivity
Proviral DNA/plasma virus bNAb sensitivity by genotypic or phenotypic analyses
Time frame: Baseline and time of ART re-initiation (visit 30) during the 60 weeks of ATI
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