Impact of a TLR9 agonist and broadly neutralizing antibodies on HIV-1 persistence: the randomized phase 2a TITAN trial

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  • Jesper D. Gunst
  • Jesper F. Højen
  • Marie H. Pahus
  • Miriam Rosás-Umbert
  • Birgitte Stiksrud
  • James H. McMahon
  • Paul W. Denton
  • Henrik Nielsen
  • Isik S. Johansen
  • Steffen Leth
  • Lars Østergaard
  • Mariane H. Schleimann
  • Rikke Olesen
  • Henrik Støvring
  • Line Vibholm
  • Anne M. Dyrhol-Riise
  • Karen B.H. Pedersen
  • Jillian S.Y. Lau
  • Dennis C. Copertino
  • Noemi Linden
  • Tan T. Huynh
  • Victor Ramos
  • R. Brad Jones
  • Sharon R. Lewin
  • Martin Tolstrup
  • Thomas A. Rasmussen
  • Michel C. Nussenzweig
  • Marina Caskey
  • Dag Henrik Reikvam
  • Ole S. Søgaard

Inducing antiretroviral therapy (ART)-free virological control is a critical step toward a human immunodeficiency virus type 1 (HIV-1) cure. In this phase 2a, placebo-controlled, double-blinded trial, 43 people (85% males) with HIV-1 on ART were randomized to (1) placebo/placebo, (2) lefitolimod (TLR9 agonist)/placebo, (3) placebo/broadly neutralizing anti-HIV-1 antibodies (bNAbs) or (4) lefitolimod/bNAb. ART interruption (ATI) started at week 3. Lefitolimod was administered once weekly for the first 8 weeks, and bNAbs were administered twice, 1 d before and 3 weeks after ATI. The primary endpoint was time to loss of virologic control after ATI. The median delay in time to loss of virologic control compared to the placebo/placebo group was 0.5 weeks (P = 0.49), 12.5 weeks (P = 0.003) and 9.5 weeks (P = 0.004) in the lefitolimod/placebo, placebo/bNAb and lefitolimod/bNAb groups, respectively. Among secondary endpoints, viral doubling time was slower for bNAb groups compared to non-bNAb groups, and the interventions were overall safe. We observed no added benefit of lefitolimod. Despite subtherapeutic plasma bNAb levels, 36% (4/11) in the placebo/bNAb group compared to 0% (0/10) in the placebo/placebo group maintained virologic control after the 25-week ATI. Although immunotherapy with lefitolimod did not lead to ART-free HIV-1 control, bNAbs may be important components in future HIV-1 curative strategies. ClinicalTrials.gov identifier: NCT03837756 .

Original languageEnglish
JournalNature Medicine
Volume29
Issue number10
Pages (from-to)2547-2558
Number of pages12
ISSN1078-8956
DOIs
Publication statusPublished - 2023

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