Combination anti-HIV antibodies provide sustained virological suppression

• Published in: Nature (London) Vol. 606; no. 7913; pp. 375 - 381
• Main Authors: Sneller, Michael C., Blazkova, Jana, Justement, J. Shawn, Shi, Victoria, Kennedy, Brooke D., Gittens, Kathleen, Tolstenko, Jekaterina, McCormack, Genevieve, Whitehead, Emily J., Schneck, Rachel F., Proschan, Michael A., Benko, Erika, Kovacs, Colin, Oguz, Cihan, Seaman, Michael S., Caskey, Marina, Nussenzweig, Michel C., Fauci, Anthony S., Moir, Susan, Chun, Tae-Wook
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 09.06.2022; Nature Publishing Group
• Subjects: 13/1; 13/106; 13/21; 13/31; 45/22; 45/23; 45/77; 45/90; 631/250/255/1901; 631/326/596/2557; Anti-HIV Agents - administration & dosage; Anti-HIV Agents - adverse effects; Anti-HIV Agents - immunology; Anti-HIV Agents - therapeutic use; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal - adverse effects; Antibodies, Monoclonal - immunology; Antibodies, Monoclonal - therapeutic use; Antibodies, Neutralizing - administration & dosage; Antibodies, Neutralizing - adverse effects; Antibodies, Neutralizing - immunology; Antibodies, Neutralizing - therapeutic use; Antiretroviral agents; Antiretroviral therapy; Antiviral agents; Binding sites; Broadly Neutralizing Antibodies - administration & dosage; Broadly Neutralizing Antibodies - adverse effects; Broadly Neutralizing Antibodies - immunology; Broadly Neutralizing Antibodies - therapeutic use; Clinical trials; Coronaviruses; COVID-19; Double-Blind Method; Drug resistance; Drug therapy; HIV; HIV Antibodies - administration & dosage; HIV Antibodies - adverse effects; HIV Antibodies - immunology; HIV Antibodies - therapeutic use; HIV Infections - drug therapy; HIV Infections - immunology; HIV Infections - virology; HIV-1 - drug effects; HIV-1 - immunology; HIV-1 - isolation & purification; Human immunodeficiency virus; Humanities and Social Sciences; Humans; Infections; Lymphocytes; Monoclonal antibodies; multidisciplinary; Neutralizing; Pandemics; Placebos; Plasma; Science; Science (multidisciplinary); Therapy; Viral Load - drug effects; Viremia; Viremia - drug therapy; Viremia - immunology; Viremia - virology; Viruses
• ISSN: 0028-0836; 1476-4687; 1476-4687
• DOI: 10.1038/s41586-022-04797-9

Antiretroviral therapy is highly effective in suppressing human immunodeficiency virus (HIV) 1 . However, eradication of the virus in individuals with HIV has not been possible to date 2 . Given that HIV suppression requires life-long antiretroviral therapy, predominantly on a daily basis, there is a need to develop clinically effective alternatives that use long-acting antiviral agents to inhibit viral replication 3 . Here we report the results of a two-component clinical trial involving the passive transfer of two HIV-specific broadly neutralizing monoclonal antibodies, 3BNC117 and 10-1074. The first component was a randomized, double-blind, placebo-controlled trial that enrolled participants who initiated antiretroviral therapy during the acute/early phase of HIV infection. The second component was an open-label single-arm trial that enrolled individuals with viraemic control who were naive to antiretroviral therapy. Up to 8 infusions of 3BNC117 and 10-1074, administered over a period of 24 weeks, were well tolerated without any serious adverse events related to the infusions. Compared with the placebo, the combination broadly neutralizing monoclonal antibodies maintained complete suppression of plasma viraemia (for up to 43 weeks) after analytical treatment interruption, provided that no antibody-resistant HIV was detected at the baseline in the study participants. Similarly, potent HIV suppression was seen in the antiretroviral-therapy-naive study participants with viraemia carrying sensitive virus at the baseline. Our data demonstrate that combination therapy with broadly neutralizing monoclonal antibodies can provide long-term virological suppression without antiretroviral therapy in individuals with HIV, and our experience offers guidance for future clinical trials involving next-generation antibodies with long half-lives. Combination therapy of broadly neutralizing monoclonal antibodies can provide long-term virological suppression in individuals infected with HIV without antiretroviral therapy.