| Eligibility |
Step 1 Inclusion Criteria:
- Confirmed HIV-1, documented by any licensed rapid HIV test or HIV enzyme or
chemiluminescence immunoassay (E/CIA) test kit at any time prior to study Step 1 entry
AND Confirmed by one of the following:
- A second antibody test from different manufacturers or based on different
principles and epitopes (combination antigen-antibody-based rapid tests may be
used)
- HIV-1 antigen
- Plasma HIV-1 RNA viral load or
- A licensed Western blot
NOTE: The term "licensed" refers to a US FDA or DAIDS Clinical Laboratory Oversight (DCLOT)
approved test.
WHO (World Health Organization) and CDC (Centers for Disease Control and Prevention)
guidelines mandate that confirmation of the initial test result must use a test that is
different from the one used for the initial assessment. A reactive initial rapid test
should be confirmed by either another type of rapid assay or an E/CIA that is based on a
different antigen preparation and/or different test principle (e.g., indirect versus
competitive), or a Western blot or a plasma HIV-1 RNA viral load.
- ART-naïve [NOTE: Prior use of PrEP or PEP is allowed, except use of long-acting ARVs
(e.g., cabotegravir, rilpivirine) within the last 24 months.]
- CD4+ T cell count >200 cells/mm3 obtained within 28 days prior to study entry at any
Network-approved non-US laboratory that is (IQA) certified.
- Plasma HIV-1 RNA >1000 copies/mL obtained within 28 days prior to study entry
performed at any Network-approved non-US laboratory that operates in accordance with
Good Clinical Laboratory Practices (GCLP) and participates in appropriate external
quality assurance (EQA) programs.
- For study candidates of child-bearing potential, negative urine or serum pregnancy
test within 72 hours prior to study entry by any Network-approved non-US laboratory or
clinic that operates in accordance with GCLP and participates in appropriate EQA
programs.
[NOTE A: Persons who are of child-bearing potential are individuals who have not been
post-menopausal for at least 24 consecutive months, who have had menses within the
preceding 24 months, and who have not undergone surgical sterilization, specifically
hysterectomy and/or bilateral oophorectomy, tubal ligation, or bilateral salpingectomy.]
[NOTE B: Acceptable documentation of hysterectomy and bilateral oophorectomy, tubal
ligation, and tubal micro-inserts are written documentation or oral communication from a
clinician or clinician's staff documented in source documents (physician report/letter,
operative report or other source documentation in the patient record, discharge summary,
laboratory report, etc.). Participant-reported history is acceptable for documentation of
menopause.]
- Persons of child-bearing potential who are able to become pregnant must agree to use
two methods of contraception, if participating in sexual activity that could lead to
pregnancy. One contraceptive method must be from the list of highly effective methods
listed below. The second method of contraception must be a barrier method or
abstinence. Both methods of contraception must be used during Step 1. The two
effective forms of birth control have to be used for 10 days before receiving the
first study drug infusion, for at least 12 months after the product infusion, and
until ART is reinitiated and viral suppression is achieved.
Acceptable methods of contraception include:
- Contraceptive subdermal implant
- Intrauterine device or intrauterine system
- Combined estrogen and progestogen oral contraceptive
- Injectable progestogen
- Contraceptive vaginal ring
- Percutaneous contraceptive patches
- Partner sterilization with documentation of azoospermia prior to the participant's
entry into the study, and this individual is the sole partner for that participant.
[NOTE: Documentation of partner sterility can come from the site personnel's review of
participant's medical records, medical examination and/or semen analysis, or medical
history interview provided by the participant or the partner. Self-reported documentation
of reproductive potential should be entered in the source documents.]
- Individuals engaging in sexual activity that could lead to their partner becoming
pregnant must agree to use a barrier method of contraception to avoid pregnancy in a
spouse or partner of reproductive potential. The barrier method must be used to
prevent partner pregnancy during Step 1 and for at least 12 months after the product
infusion.
- Ability and willingness to use a barrier protection or abstinence from sexual
intercourse during Step 1 until viral suppression is achieved, during the ATI period
(Steps 2-3), and until plasma HIV-1 RNA is less than limit of detection after ART
restart (Step 4) with partners without HIV or whose HIV serostatus is unknown in order
to prevent HIV transmission to sexual partners.
- Ability and willingness to initiate ART at enrollment.
- Ability and willingness to participate in scheduled study visits, including ATI per
the SOE.
- Ability and willingness to provide informed consent.
Step 2 Inclusion Criteria:
- Documented negative hepatitis B virus (HBV) surface antigen (HBsAg) obtained within 16
weeks prior to Step 2 registration by any Network-approved non-US laboratory that
operates in accordance with GCLP and participates in appropriate EQA programs.
- Documented negative HCV antibody (anti-HCV), negative HCV RNA PCR, or negative HCV
antigen obtained within 16 weeks prior to Step 2 registration by any Network-approved
non-US laboratory that operates in accordance with Good Clinical Laboratory Practices
(GCLP) and participates in appropriate EQA programs.
- Participants diagnosed with a bacterial sexually transmitted infection (STI) must have
initiated treatment prior to Step 2 entry.
- Receipt of both bNAb infusions or placebo infusions during Step 1.
- HIV-1 RNA <200 copies/mL obtained within 6 weeks prior to Step 2 registration at any
Network-approved non-US laboratory that is VQA certified.
- CD4+ T cell count =450 cells/mm3 obtained within 6 weeks prior to Step 2 registration
at any Network-approved non-US laboratory that is IQA certified.
- For participants of child-bearing potential, negative serum or urine pregnancy test
within 48 hours prior to Step 2 entry at any Network-approved non-US laboratory or
clinic that operates in accordance with GCLP and participates in appropriate EQA
programs.
- Ability and willingness to use a barrier method of contraception or abstinence from
sexual intercourse during Steps 2 and 3, and until plasma HIV-1 RNA is less than limit
of detection, with all partners who are without HIV or whose serostatus is unknown in
order to prevent HIV transmission to sexual partners.
- Ability and willingness to stop ART.
Step 3 Inclusion Criteria
- Has not met ART restart criteria.
- Completion of protocol Step 2.
- Willing to continue ATI.
Step 4 Inclusion Criteria
- Met ART restart criteria (section 3.0) during Step 2 or Step 3 OR Completed Step 3 and
is not enrolling to ACTG A5385.
Step 1 Exclusion Criteria:
- Any clinically significant acute or chronic medical condition, other than HIV, that in
the opinion of the investigator would preclude safe participation in the study or
interfere with the validity of study results.
- Active or recent non-HIV-associated malignancy requiring systemic chemotherapy or
surgery in the preceding 36 months or for whom such therapies are expected in the
subsequent 12 months. [NOTE: Minor surgical removal of localized skin cancers
(squamous cell carcinoma, basal cell carcinoma) are not exclusionary.]
- History of AIDS-defining illness within 3 years prior to enrollment.
- History of systemic corticosteroids (e.g., an equivalent dose of prednisone of > 20 mg
daily for >14 days), immunosuppressive anti-cancer, interleukins, systemic
interferons, systemic chemotherapy or other medications considered significant by the
trial physician within the last 12 weeks.
- History of a severe allergic reaction with generalized urticaria, angioedema, or
anaphylaxis in the 2 years prior to enrollment.
- History of chronic urticaria requiring current daily treatment.
- Known history of active Hepatitis B or Hepatitis C infection. [NOTE: Participant is
eligible if hepatitis C virus (HCV) cure or clearance is documented.]
- History of or current clinical atherosclerotic cardiovascular disease (ASCVD), as
defined by 2013 American College of Cardiology (ACC)/American Heart Association (AHA)
guidelines, including a previous diagnosis of any of the following:
- Acute myocardial infarction
- Acute coronary syndromes
- Stable or unstable angina
- Coronary or other arterial revascularization
- Stroke
- Transient ischemic attack
- Peripheral arterial disease presumed to be of atherosclerotic origin
- Any history of receipt of HIV vaccine candidate or HIV-specific monoclonal antibody
therapy.
- Participation in any clinical study of an investigational product within 28 days prior
to study entry (day 0) or expected participation in such a study during participation
in this study. [NOTE: Treatment or receipt of prophylaxis against other infectious
pathogens such as SARS-CoV-2 or Monkeypox under Emergency Use Authorization within 28
days of study entry is not exclusionary.]
- Active drug or alcohol use or dependence that, in the opinion of the site
investigator, would interfere with adherence to study requirements.
- Breastfeeding
- Laboratory abnormalities in the parameters listed below, obtained by any
Network-approved non-US laboratory that operates in accordance with Good Clinical
Laboratory Practices (GCLP) and participates in appropriate EQA programs.
- Absolute neutrophil count <750 cells/mm3
- Hemoglobin <9 gm/dL for volunteers who were assigned female sex at birth, <10.0
g/dL for volunteers who were assigned male sex at birth
- Platelet count <100,000 cells/mm3
- ALT >3 x ULN
- AST >3 x ULN
- Total bilirubin >2 x ULN
- eGFR <60 mL/min/1.73m2
- Use of prohibited medications with ART within 7 days prior to study entry, or planned
use of prohibited medications during the period of study participation.
[NOTE: Use of St. John's wort within 7 days prior to study entry is acceptable but must be
discontinued on the day of study entry]
Step 2 Exclusion Criteria:
- Viral failure after Step 1 week 24.
- Participant never started ART.
- Participant interrupted ART =7 consecutive days in Step 1.
- Current use of an ART regimen that includes a long-acting or NNRTI component.
- Intercurrent illness, new medical diagnosis, laboratory abnormality, sign, or symptom
that, in the opinion of the site investigator, would place participant at higher risk
of morbidity during ATI.
- Active drug or alcohol use or dependence that, in the opinion of the site
investigator, would interfere with adherence to study requirements.
Step 3 Exclusion Criteria
- Transfer to A5385 (The Post-Intervention Cohort Study) [NOTE: Participants may be
offered co-enrollment or transfer to A5385, depending on ACTG identification of the
preferred methodology for observation during extended ATI.]
- Intercurrent illness, new medical diagnosis, laboratory abnormality, sign, or symptom
that, in the opinion of the site investigator, would place participant at higher risk
of morbidity during analytic treatment interruption.
- Active drug or alcohol use or dependence that, in the opinion of the site
investigator, would interfere with adherence to study requirements.
Step 4 Exclusion Criteria
- None
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