Simultaneous initiation of antiretroviral treatment and immunotherapy improves HIV control

Thanks to antiretroviral therapy, HIV infection has become a chronic infection that does not interfere with the daily lives of people living with the virus. However, there is still no cure for the infection and people must maintain treatment for life, because if they abandon it, the virus comes out of hiding and returns to manifest itself in an uncontrolled way.

Now, a study published in the journal natural medicine in which the Instituto de Investigación del Sida IrsiCaixa has participated – joint center of the Fundación “la Caixa” and the Department of Health of the Generalitat de Catalunya – proposes a possible strategy to induce virus control without the need for treatment: the administration on one antibody early in antiretroviral treatment.

The clinical trial with 55 people newly diagnosed with HIV showed that the administration of immunotherapy based on the 3BNC117 antibody facilitates the elimination of HIV from the blood and improves the immune response

The clinical trial, led by the Aarhus University Hospital (Aarhus, Denmark), showed that the administration of immunotherapy based on this antibody facilitates the elimination of HIV from the blood and improves the immune response capable of eliminating infected cells. In fact, participants with antibody-sensitive viruses, called 3BNC117managed to control their HIV longer during the 12 weeks that treatment was stopped.

Until now, antibody immunotherapy studies have always been carried out with people who have been receiving antiretroviral treatment for a long time. “These new results tell us for the first time that performing the intervention early on in treatment would limit HIV persistence and this opens a new door for all of us who are dedicated to researching the eradication of this virus,” he said. explains. Javier Martinez PicadoICREA researcher at IrsiCaixa and co-author of the article.

Fewer viruses and more ability to fight it

To reach these conclusions, the team carried out a clinical trial phase 1b/2a with 55 people who had just been diagnosed with HIV and therefore started antiretroviral therapy. Of these people, 15 received this treatment exclusively, while the rest received the antiretroviral regimen in conjunction with antibody 3BNC117alone or in combination with romidepsin, a drug that has not been shown to have a significant effect in this setting.

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After one year of treatment, the results show that HIV is cleared more quickly from the blood in the group of people who received antiretroviral treatment and the 3BNC117 antibody, compared with those who received only treatment without immunotherapy. But not only that, but in people with antibody-sensitive virus decreases the number of infected cells capable of producing new viruses.

“Thanks to a technique developed and patented by IrsiCaixa called VIP-SPOT, we can detect and quantify these cells, which, in fact, are possibly responsible for the viral rebound suffered by patients when they abandon treatment,” he explains. Maria Carmen doors, Researcher at IrsiCaixa and co-author of the article. These results, in part, may be due to a increase in protective cells specifically targeted against HIVan important immune system response to gain control of the infection.

Currently, the objective of people who are dedicated to HIV research is to find a strategy that allows the control of the virus without the need for treatment.

Twelve weeks without treatment

To determine whether immunotherapy had any impact on controlling the virus in the absence of antiretroviral therapy, 20 participants stopped treatment one year after starting it. The results obtained show that virtually all people (5 in 6) with antibody-sensitive virus and who had received antiretroviral treatment and immunotherapy are maintained for 12 weeks with controlled levels of viral load. In contrast, people who received antiretroviral treatment in the absence of immunotherapy or had antibody-resistant virus had to restart treatment earlier.

Today, the goal of people doing HIV research is to find a strategy to control the virus without the need for treatment. “Results such as those obtained in this study show us possible ways to achieve this objective, that is, the functional healing. Despite the good news, more research is needed to design strategies that demonstrate their effectiveness in the entire population living with HIV”, comments Martínez-Picado.

Reference:

Jesper D. Gunst, Marie H. Pâhus, Miriam Rosás-Umbert, et al. “Early intervention with 3BNC117 and romidepsin at initiation of antiretroviral treatment in people with HIV-1: a randomized phase 1b/2a trial”. natural medicine (2022).

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