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Early Neutralizing Antibodies in Infants Living With HIV to Enhance Their Life (ENABLE 1)

12 czerwca 2026 zaktualizowane przez: Hospital Universitario 12 de Octubre

A Phase 1/2 Trial Evaluating the Safety, Pharmacokinetics, and Antiviral Activity of Subcutaneous ePGT121v1-LS, Added to Standard Antiretroviral Therapy in Infants Living With HIV

The goal of this clinical trial is to learn if subcutaneous ePGT121v1-LS added to standard antiretroviral therapy (ART) is safe and helps improve HIV viral suppression in infants living with HIV in South Africa. The study will also learn how the body processes ePGT121v1-LS and whether caregivers and health workers find this treatment approach acceptable.

The main questions it aims to answer are:

  • Is ePGT121v1-LS safe and well tolerated in infants living with HIV?
  • Does adding ePGT121v1-LS to standard ART increase the number of infants who achieve HIV viral suppression by week 48?
  • How long does it take participants receiving ePGT121v1-LS to achieve viral suppression compared with standard treatment alone?
  • How does ePGT121v1-LS behave in the body after repeated subcutaneous injections?

Researchers will compare infants receiving ePGT121v1-LS plus ART to infants receiving standard ART plus placebo (saline) to see if ePGT121v1-LS improves HIV viral suppression.

Participants will:

  • Continue taking standard oral ART.
  • Receive 4 subcutaneous injections of ePGT121v1-LS or placebo every 12 weeks.
  • Attend regular clinic visits for safety checks, blood tests, and HIV viral load monitoring.
  • Have follow-up visits for 48 weeks.
  • Participate in evaluations of treatment adherence and acceptability from the perspective of caregivers and health workers.

Przegląd badań

Status

Jeszcze nie rekrutacja

Warunki

Interwencja / Leczenie

Szczegółowy opis

This Phase 1/2 clinical trial is designed to evaluate the safety, tolerability, pharmacokinetics, and antiviral activity of subcutaneous (SC) ePGT121v1-LS administered as adjunctive therapy to standard antiretroviral therapy (ART) in infants living with HIV (ILHIV) in South Africa.

Although early ART initiation has significantly improved survival among infants with HIV, achieving sustained virological suppression during infancy remains challenging because of factors including limited pediatric formulations, adherence difficulties, high baseline viral loads, and treatment interruptions. Novel long-acting therapeutic strategies that simplify treatment delivery and enhance antiviral activity may improve outcomes in this vulnerable population.

Broadly neutralizing antibodies (bNAbs) have shown antiviral activity in adults and children living with HIV and may provide additional benefits through prolonged antiviral coverage and immunomodulatory effects. ePGT121v1-LS is a long-acting bNAb directed against the V3 glycan supersite of the HIV-1 envelope. The LS mutation extends antibody half-life and supports infrequent dosing schedules using SC administration.

This study includes an initial safety lead-in phase followed by a randomized placebo-controlled phase evaluating ePGT121v1-LS in combination with standard ART. The trial will assess the safety profile and tolerability of repeated SC administrations and will characterize pharmacokinetic parameters following serial dosing in infants. In addition, the study will evaluate the antiviral effect of ePGT121v1-LS intensification therapy on HIV viral suppression during the first 48 weeks of follow-up.

Exploratory analyses will further assess virological, immunological, and reservoir-related outcomes, including HIV-1 DNA dynamics, viral diversity, neutralization sensitivity, anti-drug antibodies, and immune responses associated with bNAb exposure. Qualitative assessments will also evaluate the acceptability and feasibility of SC bNAb administration from the perspective of caregivers, healthcare workers, and stakeholders.

The results of this study are intended to inform the development of future pediatric trials evaluating long-acting bNAb-based therapeutic strategies for infants living with HIV.

Typ studiów

Interwencyjne

Zapisy (Szacowany)

87

Faza

  • Faza 2
  • Faza 1

Kontakty i lokalizacje

Ta sekcja zawiera dane kontaktowe osób prowadzących badanie oraz informacje o tym, gdzie badanie jest przeprowadzane.

Kontakt w sprawie studiów

Kryteria uczestnictwa

Badacze szukają osób, które pasują do określonego opisu, zwanego kryteriami kwalifikacyjnymi. Niektóre przykłady tych kryteriów to ogólny stan zdrowia danej osoby lub wcześniejsze leczenie.

Kryteria kwalifikacji

Wiek uprawniający do nauki

  • Dziecko

Akceptuje zdrowych ochotników

Nie

Opis

Inclusion Criteria:

  • Infants from 1 to 365 days old at the time of enrolment.
  • Living with HIV-1, diagnosed with an approved assay detecting HIV nucleic acids in blood.
  • Weight > 2.5 kg at enrolment.
  • ART-naïve or ≤ 30 days of triple ART at screening (not including prophylaxis in HIV-exposed).
  • Clinically stable and can be managed as outpatient (participants identified in-hospital can start the trial at their first routine visit).
  • Parent or legal guardian able to provide Informed consent (IC).

Exclusion Criteria:

  • Participation in other concurrent research studies that, in the opinion of the principal investigator and central team, would interfere with the objectives of this study.
  • Previous receipt of bNAbs against HIV.
  • Serious Adverse Reactions (SARs) to the investigational medicinal product (IMP) or its components.
  • Intravenous (IV) immunoglobulins received within 90 days before IMP administration.
  • Any clinically significant acute or chronic illness or condition at screening that, in the opinion of the principal investigator/designee, renders the participant unfit to participate in the study or jeopardizes the safety or rights of the participant. Including, but not restricted to:
  • Evidence of active tuberculosis (TB) disease at the time of enrolment.
  • Life-threatening condition associated with a high risk of death within 30 days of enrolment, as determined by the study clinician.
  • Severe acute malnutrition with complications.
  • Severe neurological illness.
  • Hemodynamically significant severe congenital heart disease.
  • Active malignancies.
  • Life-threatening bleeding disorder.
  • Use of systemic immunosuppressive drugs within 30 days before first IMP administration. Not exclusionary: nasal steroid spray, inhaled steroids, topical steroids, a single course of oral/parenteral prednisone or equivalent at 2 mg/kg/day, and length of therapy <14 days.
  • Unwillingness to have blood drawn
  • Unable to receive SC medications.
  • Chronic or recurrent urticaria or any other chronic dermatological condition that may be confused with local Adverse Reactions (ARs).

Any social or medical condition in the caregivers that, in the judgement of the investigator, would interfere with protocol adherence, completion of the trial or assessment of safety.

Plan studiów

Ta sekcja zawiera szczegółowe informacje na temat planu badania, w tym sposób zaprojektowania badania i jego pomiary.

Jak projektuje się badanie?

Szczegóły projektu

  • Główny cel: Leczenie
  • Przydział: Randomizowane
  • Model interwencyjny: Przydział równoległy
  • Maskowanie: Podwójnie

Broń i interwencje

Grupa uczestników / Arm
Interwencja / Leczenie
Komparator placebo: Placebo (saline)
4 injections of saline, separated 12 weeks, plus antiretroviral treatment.
Lek: Saline (0.9% NaCl)
Administration of subcutaneous saline, 4 doses, separate 12 weeks away.
Aktywny komparator: ePGT121v1-LS
4 injections of the bNAb ePGT121v1-LS, separated 12 weeks, plus antiretroviral treatment.
Lek: Broadly neutralizing antibody (bNAb) ePGT121v1-LS
Administration of subcutaneous ePGT121v1LS, 4 doses, separate 12 weeks away.

Co mierzy badanie?

Podstawowe miary wyniku

Miara wyniku
Opis środka
Ramy czasowe
Safety (Serious adverse events)
Ramy czasowe: 48 weeks
Proportion of participants experiencing SAEs throughout the whole trial.
48 weeks
Time to virological suppression
Ramy czasowe: 48 weeks
• Time to first virological suppression, defined as the time from randomization to the first post-baseline measurement of plasma HIV-1 RNA < 40 copies/mL.
48 weeks
Tolerability of the treatment (participants who discontinue)
Ramy czasowe: 48 weeks
• Proportion of participants who discontinue due to toxicity or tolerability issues.
48 weeks
Tolerability of the injection
Ramy czasowe: 1 hour
• Median score of pain assessment scale after administration of bNAb (FLACC scale).
1 hour
Virological suppression (snapshot)
Ramy czasowe: 48 weeks
• Proportion of infants achieving virological suppression (plasma HIV-1 RNA < 40 copies/mL) at week 48, as well as over the 48 week follow-up period.
48 weeks

Miary wyników drugorzędnych

Miara wyniku
Opis środka
Ramy czasowe
Time to sustained virological suppression
Ramy czasowe: 48 weeks
Time from randomization to the first scheduled post-baseline visit at which HIV-1 RNA is < 40 copies/mL, provided that all subsequent scheduled HIV-1 RNA measurements through week 48 also remain < 40 copies/mL.
48 weeks
Longitudinal virological response
Ramy czasowe: 48 weeks
Proportion of participants with HIV-1 RNA < 40 copies/mL at weeks 12, 24, 36, and 48 will be recorded as the endpoint and log change in plasma HIV-1 RNA levels relative to baseline and subsequent pre-dose measurements.
48 weeks
Acceptability
Ramy czasowe: 48 weeks
The acceptability will be assessed through a series of qualitative interviews and limited quantitative assessments.
48 weeks
Adverse events
Ramy czasowe: 48 weeks
Number of and proportion of participants with solicited adverse event (AEs) and laboratory-related AEs.
48 weeks
PK profile of ePGT121v1-LS
Ramy czasowe: 12 weeks
Half-life
12 weeks

Inne miary wyników

Miara wyniku
Opis środka
Ramy czasowe
All-cause mortality and number of hospitalizations.
Ramy czasowe: 48 weeks
All-cause mortality and number of hospitalizations.
48 weeks
Clinical features at baseline and during follow-up
Ramy czasowe: 48 weeks
This exploratory objective will include a comprehensive evaluation of different clinical parameters such as demographics (age, gestational age, weight, Prevention of Mother-To-Child Transmission (PMTCT) interventions), HIV disease severity (VL, CD4+ T-cell count/percentage), nutritional status, comorbidities (infectious and non-infectious), and ART (time to initiation, adherence during follow-up).
48 weeks
HIV-1 DNA
Ramy czasowe: 48 weeks
The concentration of intact and defective HIV-1 proviral DNA, expressed as copies per million of peripheral blood mononuclear cells (PBMCs), measured by intact proviral DNA assay (IPDA) and quantified at baseline and week 48
48 weeks
Anti-drug antibodies (ADAs)
Ramy czasowe: 48 weeks
The titers of ADAs will be quantified at baseline and week 48 to assess whether the development of host antibodies (anti-bNAbs) contributes to virological failure among infants who experience viral rebound by week 48, compared to infants with virological suppression at week 48.
48 weeks
Neutralizing Activity
Ramy czasowe: 48 weeks
Neutralization titers will be calculated as IC50 (50% inhibitory concentration) and IC80 (80% inhibitory concentration) by TZM-bl luciferase reporter assay. In vitro susceptibility of env-pseudotyped viruses derived from all participants at baseline and from those experiencing breakthrough viremia at week 48 will be used to establish whether in vitro susceptibility predicts virological success
48 weeks
Immunophenotype
Ramy czasowe: 48 weeks
Cellular immunophenotype will be measured using AIM-ICS flow cytometry to determine the activation status and cytokine production of T-cells and NK cells.
48 weeks
HIV-1 Env Diversity
Ramy czasowe: 48 weeks
Comprehensive single-genome sequencing (SGS) of HIV-1 breakthrough and pre-treatment sequences to identify acquired mutations that might be associated with viral escape and phenotypic resistance to bNAb therapy in infants that do not achieve viral suppression by week 48. Additionally, these sequences will be compared to the baseline profiles of infants who did achieve suppression to identify potential genotypic predictors of treatment success or failure.
48 weeks

Współpracownicy i badacze

Tutaj znajdziesz osoby i organizacje zaangażowane w to badanie.

Sponsor

Hospital Universitario 12 de Octubre

Współpracownicy

International AIDS Vaccine Initiative
University of Stellenbosch
University of Witwatersrand, South Africa
PENTA Foundation
Africa Health Research Institute
Faculty of Medical Sciences, Radboud University of Medical Center
Servicio Madrileño de Salud (SERMAS)
Enhancing Care Foundation

Daty zapisu na studia

Daty te śledzą postęp w przesyłaniu rekordów badań i podsumowań wyników do ClinicalTrials.gov. Zapisy badań i zgłoszone wyniki są przeglądane przez National Library of Medicine (NLM), aby upewnić się, że spełniają określone standardy kontroli jakości, zanim zostaną opublikowane na publicznej stronie internetowej.

Główne daty studiów

Rozpoczęcie studiów (Szacowany)

1 stycznia 2027

Zakończenie podstawowe (Szacowany)

1 lipca 2029

Ukończenie studiów (Szacowany)

31 grudnia 2029

Daty rejestracji na studia

Pierwszy przesłany

9 czerwca 2026

Pierwszy przesłany, który spełnia kryteria kontroli jakości

12 czerwca 2026

Pierwszy wysłany (Rzeczywisty)

17 czerwca 2026

Aktualizacje rekordów badań

Ostatnia wysłana aktualizacja (Rzeczywisty)

17 czerwca 2026

Ostatnia przesłana aktualizacja, która spełniała kryteria kontroli jakości

12 czerwca 2026

Ostatnia weryfikacja

1 czerwca 2026

Więcej informacji

Terminy związane z tym badaniem

Słowa kluczowe

Dodatkowe istotne warunki MeSH

Inne numery identyfikacyjne badania

  • 101190620_1

Plan dla danych uczestnika indywidualnego (IPD)

Planujesz udostępniać dane poszczególnych uczestników (IPD)?

TAK

Opis planu IPD

The individual de-identified participant data (including data dictionary), statistical code, and any other materials will be accessible after the end of the project in an open repository upon request.

Ramy czasowe udostępniania IPD

The individual de-identified participant data (including data dictionary), statistical code, and any other materials will be accessible after the end of the project in an open repository upon request.

Kryteria dostępu do udostępniania IPD

Upon reasonable request.

Typ informacji pomocniczych dotyczących udostępniania IPD

  • PROTOKÓŁ BADANIA
  • SOK ROŚLINNY

Informacje o lekach i urządzeniach, dokumenty badawcze

Bada produkt leczniczy regulowany przez amerykańską FDA

Tak

Bada produkt urządzenia regulowany przez amerykańską FDA

Nie

Te informacje zostały pobrane bezpośrednio ze strony internetowej clinicaltrials.gov bez żadnych zmian. Jeśli chcesz zmienić, usunąć lub zaktualizować dane swojego badania, skontaktuj się z register@clinicaltrials.gov. Gdy tylko zmiana zostanie wprowadzona na stronie clinicaltrials.gov, zostanie ona automatycznie zaktualizowana również na naszej stronie internetowej .

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