Prolonged viral suppression with anti-HIV-1 antibody therapy
Christian Gaebler, Lilian Nogueira, Elina Stoffel, Thiago Y Oliveira, Gaëlle Breton, Katrina G Millard, Martina Turroja, Allison Butler, Victor Ramos, Michael S Seaman, Jacqueline D Reeves, Christos J Petroupoulos, Irina Shimeliovich, Anna Gazumyan, Caroline S Jiang, Nikolaus Jilg, Johannes F Scheid, Rajesh Gandhi, Bruce D Walker, Michael C Sneller, Anthony Fauci, Tae-Wook Chun, Marina Caskey, Michel C Nussenzweig, Christian Gaebler, Lilian Nogueira, Elina Stoffel, Thiago Y Oliveira, Gaëlle Breton, Katrina G Millard, Martina Turroja, Allison Butler, Victor Ramos, Michael S Seaman, Jacqueline D Reeves, Christos J Petroupoulos, Irina Shimeliovich, Anna Gazumyan, Caroline S Jiang, Nikolaus Jilg, Johannes F Scheid, Rajesh Gandhi, Bruce D Walker, Michael C Sneller, Anthony Fauci, Tae-Wook Chun, Marina Caskey, Michel C Nussenzweig
Abstract
HIV-1 infection remains a public health problem with no cure. Anti-retroviral therapy (ART) is effective but requires lifelong drug administration owing to a stable reservoir of latent proviruses integrated into the genome of CD4+ T cells1. Immunotherapy with anti-HIV-1 antibodies has the potential to suppress infection and increase the rate of clearance of infected cells2,3. Here we report on a clinical study in which people living with HIV received seven doses of a combination of two broadly neutralizing antibodies over 20 weeks in the presence or absence of ART. Without pre-screening for antibody sensitivity, 76% (13 out of 17) of the volunteers maintained virologic suppression for at least 20 weeks off ART. Post hoc sensitivity analyses were not predictive of the time to viral rebound. Individuals in whom virus remained suppressed for more than 20 weeks showed rebound viraemia after one of the antibodies reached serum concentrations below 10 µg ml-1. Two of the individuals who received all seven antibody doses maintained suppression after one year. Reservoir analysis performed after six months of antibody therapy revealed changes in the size and composition of the intact proviral reservoir. By contrast, there was no measurable decrease in the defective reservoir in the same individuals. These data suggest that antibody administration affects the HIV-1 reservoir, but additional larger and longer studies will be required to define the precise effect of antibody immunotherapy on the reservoir.
Conflict of interest statement
There are patents on 3BNC117 (PTC/US2012/038400) and 10-1074 (PTC/US2013/065696) that list M.C.N. and J.F.S. as inventors. 3BNC117 and 10-1074 are licensed to Gilead by Rockefeller University from which M.C.N. and J.F.S. have received payments. M.C.N. is a member of the Scientific Advisory Boards of Celldex, Walking Fish, and Frontier Biotechnologies. J.F.S. and M.C.N had no control over the direction, and ultimately the reporting, of the clinical portion of the research while holding their financial interests, which were reviewed and are managed by the Rockefeller University and Massachusetts General Hospital and Mass General Brigham in accordance with their conflict of interest policies. J.D.R and C.J.P. are employees of Labcorp-Monogram Biosciences.
© 2022. The Author(s).
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References
- Margolis DM, Archin NM. Proviral latency, persistent human immunodeficiency virus infection, and the development of latency reversing agents. J. Infect. Dis. 2017;215:S111–S118. doi: 10.1093/infdis/jiw618.
- Bournazos S, DiLillo DJ, Ravetch JV. The role of Fc–FcγR interactions in IgG-mediated microbial neutralization. J. Exp. Med. 2015;212:1361–1369. doi: 10.1084/jem.20151267.
- Caskey M. Broadly neutralizing antibodies for the treatment and prevention of HIV infection. Curr. Opin. HIV AIDS. 2020;15:49–55. doi: 10.1097/COH.0000000000000600.
- Li JZ, et al. The size of the expressed HIV reservoir predicts timing of viral rebound after treatment interruption. AIDS. 2016;30:343–353.
- Liu B, et al. Broadly neutralizing antibody-derived CAR T cells reduce viral reservoir in individuals infected with HIV-1. J. Clin. Invest. 2021;131:e150211. doi: 10.1172/JCI150211.
- SenGupta D, et al. The TLR7 agonist vesatolimod induced a modest delay in viral rebound in HIV controllers after cessation of antiretroviral therapy. Sci. Transl. Med. 2021;13:eabg3071. doi: 10.1126/scitranslmed.abg3071.
- Halper-Stromberg A, et al. Broadly neutralizing antibodies and viral inducers decrease rebound from HIV-1 latent reservoirs in humanized mice. Cell. 2014;158:989–999. doi: 10.1016/j.cell.2014.07.043.
- Nishimura Y, et al. Early antibody therapy can induce long-lasting immunity to SHIV. Nature. 2017;543:559–563. doi: 10.1038/nature21435.
- Nishimura Y, et al. Immunotherapy during the acute SHIV infection of macaques confers long-term suppression of viremia. J. Exp. Med. 2021;218:e20201214. doi: 10.1084/jem.20201214.
- Bar KJ, et al. Effect of HIV antibody VRC01 on viral rebound after treatment interruption. N. Engl. J. Med. 2016;375:2037–2050. doi: 10.1056/NEJMoa1608243.
- Caskey M, et al. Antibody 10-1074 suppresses viremia in HIV-1-infected individuals. Nat. Med. 2017;23:185–191. doi: 10.1038/nm.4268.
- Mendoza P, et al. Combination therapy with anti-HIV-1 antibodies maintains viral suppression. Nature. 2018;561:479–484. doi: 10.1038/s41586-018-0531-2.
- Scheid JF, et al. HIV-1 antibody 3BNC117 suppresses viral rebound in humans during treatment interruption. Nature. 2016;535:556–560. doi: 10.1038/nature18929.
- Corey L, et al. Two randomized trials of neutralizing antibodies to prevent HIV-1 acquisition. N. Engl. J. Med. 2021;384:1003–1014. doi: 10.1056/NEJMoa2031738.
- Bar-On Y, et al. Safety and antiviral activity of combination HIV-1 broadly neutralizing antibodies in viremic individuals. Nat. Med. 2018;24:1701–1707. doi: 10.1038/s41591-018-0186-4.
- Mouquet H, et al. Complex-type N-glycan recognition by potent broadly neutralizing HIV antibodies. Proc. Natl Acad. Sci. USA. 2012;109:E3268–E3277.
- Mouquet H, et al. Memory B cell antibodies to HIV-1 gp140 cloned from individuals infected with clade A and B viruses. PLoS ONE. 2011;6:e24078. doi: 10.1371/journal.pone.0024078.
- Sarzotti-Kelsoe M, et al. Optimization and validation of the TZM-bl assay for standardized assessments of neutralizing antibodies against HIV-1. J. Immunol. Methods. 2014;409:131–146. doi: 10.1016/j.jim.2013.11.022.
- Miura T, et al. HLA-B57/B*5801 human immunodeficiency virus type 1 elite controllers select for rare gag variants associated with reduced viral replication capacity and strong cytotoxic T-lymphocyte [corrected] recognition. J. Virol. 2009;83:2743–2755. doi: 10.1128/JVI.02265-08.
- Sneller, M. C. et al. Combination anti-HIV antibodies provide sustained virologic suppression. Nature (in the press).
- Gaebler C, et al. Combination of quadruplex qPCR and next-generation sequencing for qualitative and quantitative analysis of the HIV-1 latent reservoir. J. Exp. Med. 2019;216:2253–2264. doi: 10.1084/jem.20190896.
- Bertagnolli LN, et al. Autologous IgG antibodies block outgrowth of a substantial but variable fraction of viruses in the latent reservoir for HIV-1. Proc. Natl Acad. Sci. USA. 2020;117:32066–32077. doi: 10.1073/pnas.2020617117.
- Cohen YZ, et al. Relationship between latent and rebound viruses in a clinical trial of anti-HIV-1 antibody 3BNC117. J. Exp. Med. 2018;215:2311–2324. doi: 10.1084/jem.20180936.
- Abdel-Mohsen M, et al. Recommendations for measuring HIV reservoir size in cure-directed clinical trials. Nat. Med. 2020;26:1339–1350. doi: 10.1038/s41591-020-1022-1.
- Cho A, et al. Longitudinal clonal dynamics of HIV-1 latent reservoirs measured by combination quadruplex polymerase chain reaction and sequencing. Proc. Natl Acad. Sci. USA. 2022;119:e2117630119. doi: 10.1073/pnas.2117630119.
- Peluso MJ, et al. Differential decay of intact and defective proviral DNA in HIV-1-infected individuals on suppressive antiretroviral therapy. JCI Insight. 2020;5:e132997. doi: 10.1172/jci.insight.132997.
- Falcinelli SD, et al. Longitudinal dynamics of intact HIV proviral DNA and outgrowth virus frequencies in a cohort of individuals receiving antiretroviral therapy. J. Infect. Dis. 2021;224:92–100. doi: 10.1093/infdis/jiaa718.
- Gandhi RT, et al. Selective decay of intact HIV-1 proviral DNA on antiretroviral therapy. J. Infect. Dis. 2021;223:225–233. doi: 10.1093/infdis/jiaa532.
- Margolis DM, Deeks SG. How unavoidable are analytical treatment interruptions in HIV cure-related studies? J. Infect. Dis. 2019;220:S24–S26. doi: 10.1093/infdis/jiz222.
- Einkauf KB, et al. Intact HIV-1 proviruses accumulate at distinct chromosomal positions during prolonged antiretroviral therapy. J. Clin. Invest. 2019;129:988–998. doi: 10.1172/JCI124291.
- Cohn LB, et al. HIV-1 integration landscape during latent and active infection. Cell. 2015;160:420–432. doi: 10.1016/j.cell.2015.01.020.
- Huang AS, et al. Integration features of intact latent HIV-1 in CD4+ T cell clones contribute to viral persistence. J. Exp. Med. 2021;218:e20211427. doi: 10.1084/jem.20211427.
- Hill AL, Rosenbloom DI, Fu F, Nowak MA, Siliciano RF. Predicting the outcomes of treatment to eradicate the latent reservoir for HIV-1. Proc. Natl Acad. Sci. USA. 2014;111:13475–13480. doi: 10.1073/pnas.1406663111.
- Chun TW, et al. Quantification of latent tissue reservoirs and total body viral load in HIV-1 infection. Nature. 1997;387:183–188. doi: 10.1038/387183a0.
- Lorenzi JC, et al. Paired quantitative and qualitative assessment of the replication-competent HIV-1 reservoir and comparison with integrated proviral DNA. Proc. Natl Acad. Sci. USA. 2016;113:E7908–E7916. doi: 10.1073/pnas.1617789113.
- Hiener B, et al. Identification of genetically intact HIV-1 proviruses in specific CD4+ T cells from effectively treated participants. Cell Rep. 2017;21:813–822. doi: 10.1016/j.celrep.2017.09.081.
- Ho YC, et al. Replication-competent noninduced proviruses in the latent reservoir increase barrier to HIV-1 cure. Cell. 2013;155:540–551. doi: 10.1016/j.cell.2013.09.020.
- Bruner KM, et al. A quantitative approach for measuring the reservoir of latent HIV-1 proviruses. Nature. 2019;566:120–125. doi: 10.1038/s41586-019-0898-8.
- Gaebler, C. et al. Sequence evaluation and comparative analysis of novel assays for intact proviral HIV-1 DNA. J. Virol.10.1128/JVI.01986-20 (2020).
- Antar AA, et al. Longitudinal study reveals HIV-1-infected CD4+ T cell dynamics during long-term antiretroviral therapy. J. Clin. Invest. 2020;130:3543–3559. doi: 10.1172/JCI135953.
- Siliciano JD, et al. Long-term follow-up studies confirm the stability of the latent reservoir for HIV-1 in resting CD4+ T cells. Nat. Med. 2003;9:727–728. doi: 10.1038/nm880.
- Bruner KM, et al. Defective proviruses rapidly accumulate during acute HIV-1 infection. Nat. Med. 2016;22:1043–1049. doi: 10.1038/nm.4156.
- Mendoza P, et al. Antigen-responsive CD4+ T cell clones contribute to the HIV-1 latent reservoir. J. Exp. Med. 2020;217:e20200051. doi: 10.1084/jem.20200051.
- Simonetti FR, et al. Antigen-driven clonal selection shapes the persistence of HIV-1-infected CD4+ T cells in vivo. J. Clin. Invest. 2021;131:e145254. doi: 10.1172/JCI145254.
- Schiralli Lester GM, Henderson AJ. Mechanisms of HIV transcriptional regulation and their contribution to latency. Mol. Biol. Int. 2012;2012:614120. doi: 10.1155/2012/614120.
- Gandhi RT, et al. HIV-1 directly kills CD4+ T cells by a Fas-independent mechanism. J. Exp. Med. 1998;187:1113–1122. doi: 10.1084/jem.187.7.1113.
- Hosmane NN, et al. Proliferation of latently infected CD4+ T cells carrying replication-competent HIV-1: Potential role in latent reservoir dynamics. J. Exp. Med. 2017;214:959–972. doi: 10.1084/jem.20170193.
- Badley AD, Sainski A, Wightman F, Lewin SR. Altering cell death pathways as an approach to cure HIV infection. Cell Death Dis. 2013;4:e718. doi: 10.1038/cddis.2013.248.
- Cohn LB, et al. Clonal CD4+ T cells in the HIV-1 latent reservoir display a distinct gene profile upon reactivation. Nat. Med. 2018;24:604–609. doi: 10.1038/s41591-018-0017-7.
- Niessl J, et al. Combination anti-HIV-1 antibody therapy is associated with increased virus-specific T cell immunity. Nat. Med. 2020;26:222–227. doi: 10.1038/s41591-019-0747-1.
- Salazar-Gonzalez JF, et al. Deciphering human immunodeficiency virus type 1 transmission and early envelope diversification by single-genome amplification and sequencing. J. Virol. 2008;82:3952–3970. doi: 10.1128/JVI.02660-07.
- Nurk, S. et al. in Research in Computational Molecular Biology (eds Deng, M. et al.) 158–170 (Springer, 2013).
- West AP, Jr., et al. Computational analysis of anti-HIV-1 antibody neutralization panel data to identify potential functional epitope residues. Proc. Natl Acad. Sci. USA. 2013;110:10598–10603. doi: 10.1073/pnas.1309215110.
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