Analytical treatment interruption among women with HIV in southern Africa who received VRC01 or placebo in the Antibody Mediated Prevention Study: ATI stakeholder engagement, implementation and early clinical data
Year: 2025
Type: article
Abstract: INTRODUCTION: Antiretroviral therapy (ART) prevents and treats, but does not eradicate, HIV. Early ART initiation is associated with post-ART virologic control, particularly among African women, and anti-HIV-1 broadly neutralizing antibodies (bnAbs) may modulate immune responses to HIV. We evaluate whether early ART with or without anti-HIV-1 bnAb VRC01, present at HIV acquisition, is associated with later ART-free control in African women and we assess potential associations with observed control. METHODS: Stakeholder engagement informed analytical treatment interruption (ATI) study design and implementation. Participants who received placebo or VRC01 and acquired HIV in the Antibody Mediated Prevention efficacy trial were assessed for ATI eligibility, including HIV acquisition within 8 weeks of receiving VRC01 or placebo, followed by early ART initiation and ≥1 year of viral suppression. Participation facilitators and barriers were assessed. From May 2021 to February 2024, participants enrolled, stopped ART and received frequent viral load and CD4+ T-cell count monitoring for safety and assessment of meeting ART reinitiation criteria. RESULTS: Thirteen women enrolled from southern Africa. No ATI-related serious adverse events (AEs), HIV transmissions, pregnancies or ≥Grade 2 AEs were observed. Eight sexually transmitted infections were diagnosed in seven women during ATI. Two participants had tenofovir levels consistent with use during ATI; 2/11 (18%) who completed ATI without antiretroviral use exhibited ART-free control for ≥32 weeks. The median time to confirmed VL≥200 was 5.4 weeks (range 2.7-112). The most common ART reinitiation criterion met was virologic (n = 7). VRC01 receipt proximate to HIV acquisition was not associated with control. Controllers versus non-controllers did not differ by early post-acquisition viral load kinetics, acquired virus characteristics, or time from estimated acquisition to closest infusion or to ART initiation. CONCLUSIONS: In a safe, well-tolerated ATI, 18% of 11 African women exhibited post-intervention control. Design and implementation lessons inform future ATIs in Africa. Analyses of peri-acquisition and post-ATI host and viral characteristics can inform the development of interventions for HIV cure, prevention and treatment. CLINICAL TRIAL REGISTRATION: NCT04860323.
DOI: 10.1002/jia2.26495
Authors: Shelly Karuna, Fatima Laher, Sufia Dadabhai, Pei‐Chun Yu, Doug Grove, Catherine Orrell, Joseph Makhema, Mina C. Hosseinipour, Carrie‐Anne Mathew, William Brumskine, Nyaradzo Mgodi, Philip Andrew, Lucio Gama, Carissa Karg, Gail Broder, Kagisho Baepanye, Jonathan Lucas, Michele Andrasik, Simbarashe Takuva, Manuel Villaran, Azwidihwi Takalani, Randall Tressler, Lydia Soto‐Torres, Amanda S. Woodward Davis, Ames Dhai, Ian M. Sanne, Myron S. Cohen, Lawrence Corey, Glenda Gray, Allan C. deCamp, Katharine J. Bar
Institutions: Fred Hutch Cancer Center, University of the Witwatersrand, Perinatal HIV Research Unit, Johns Hopkins University, University of Cape Town, Institute of Infectious Disease and Molecular Medicine, Harvard University, Botswana Harvard AIDS Institute Partnership, University of North Carolina at Chapel Hill, Vanderbilt University, Aurum Institute, University of Zimbabwe, Family Health International 360, National Institutes of Health, Vaccine Research Center, University of Pretoria, Chris Hani Baragwanath Hospital, National Institute of Allergy and Infectious Diseases, South African Medical Research Council, University of Washington, University of Pennsylvania
Language: English
Topic: HIV Research and Treatment
Subfield: Virology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $2,600
Funders: Vanderbilt University, University of Pennsylvania, University of Washington, Johns Hopkins University, Harvard T.H. Chan School of Public Health, FHI 360, ACT Government, South African Medical Research Council, University of Pretoria, University of Cape Town, National Institutes of Health, School of Medicine, Vanderbilt University, University of North Carolina at Chapel Hill, Perelman School of Medicine, University of Pennsylvania, Johns Hopkins Bloomberg School of Public Health, National Institute of Allergy and Infectious Diseases
Awards: HIV Prevention trials Network (HPTN) Coordinating and Operations Center, Units for HIV/AIDS Clinical Trials Networks, G7522203623, G9000028484, UZ-UCSF CTU, HIV Prevention Trials Network Leadership and Operations Center, HIV Vaccines Clinical Trials Network Leadership and Operations Center, SDMC: HIV Vaccine Trials Network, The Johns Hopkins University-Blantyre Clinical Trials Unit, Aurum Clinical Trials Unit, University of North Carolina Global HIV Prevention and Treatment Clinical Trials Unit, Wits HIV Research Group CLINICAL TRIAL UNIT (CTU) reapplication
OpenAlex ID: W4411041394