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The RIO trial: rationale, design, and the role of community involvement in a randomised placebo-controlled trial of antiretroviral therapy plus dual long-acting HIV-specific broadly neutralising antibodies (bNAbs) in participants diagnosed with recent HIV infection-study protocol for a two-stage randomised phase II trial.
Lee, Ming Jie; Collins, Simon; Babalis, Daphne; Johnson, Nicholas; Falaschetti, Emanuela; Prevost, A Toby; Ashraf, Ambreen; Jacob, Milaana; Cole, Tom; Hurley, Lisa; Pace, Matthew; Ogbe, Ane; Khan, Maryam; Zacharopoulou, Panagiota; Brown, Helen; Sutherland, Euan; Box, Hanna; Fox, Julie; Deeks, Steven; Horowitz, Jill; Nussenzweig, Michel C; Caskey, Marina; Frater, John; Fidler, Sarah.
  • Lee MJ; Department of Infectious Disease, Imperial College London, London, UK. minglee@doctors.org.uk.
  • Collins S; HIV i-Base, London, UK.
  • Babalis D; Imperial Clinical Trials Unit, School of Public health, Imperial College London, London, UK.
  • Johnson N; Imperial Clinical Trials Unit, School of Public health, Imperial College London, London, UK.
  • Falaschetti E; Imperial Clinical Trials Unit, School of Public health, Imperial College London, London, UK.
  • Prevost AT; King's Clinical Trials Unit, King's College London, London, UK.
  • Ashraf A; Imperial Clinical Trials Unit, School of Public health, Imperial College London, London, UK.
  • Jacob M; Imperial Clinical Trials Unit, School of Public health, Imperial College London, London, UK.
  • Cole T; Imperial Clinical Trials Unit, School of Public health, Imperial College London, London, UK.
  • Hurley L; NIHR Imperial Clinical Research Facility, Imperial College London, London, UK.
  • Pace M; Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK.
  • Ogbe A; Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK.
  • Khan M; Department of Infectious Disease, Imperial College London, London, UK.
  • Zacharopoulou P; Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK.
  • Brown H; Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK.
  • Sutherland E; Imperial College Clinical Trials Centre, Imperial College Healthcare NHS Trust, London, UK.
  • Box H; Department of Infectious Disease, Imperial College London, London, UK.
  • Fox J; Harrison Wing, Guy's and St Thomas Hospital NHS Foundation Trust, London, UK.
  • Deeks S; Department of Medicine, University of California, San Francisco, CA, 94110, USA.
  • Horowitz J; Laboratory of Molecular Immunology, The Rockefeller University, New York, USA.
  • Nussenzweig MC; Laboratory of Molecular Immunology, The Rockefeller University, New York, USA.
  • Caskey M; Laboratory of Molecular Immunology, The Rockefeller University, New York, USA.
  • Frater J; Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK.
  • Fidler S; Department of Infectious Disease, Imperial College London, London, UK.
Trials ; 23(1): 263, 2022 Apr 05.
Article in English | MEDLINE | ID: covidwho-1779666
ABSTRACT

BACKGROUND:

Antiretroviral therapy (ART) has led to dramatic improvements in survival for people living with HIV, but is unable to cure infection, or induce viral control off therapy. Designing intervention trials with novel agents with the potential to confer a period of HIV remission without ART remains a key scientific and community goal. We detail the rationale, design, and outcomes of a randomised, placebo-controlled trial of two HIV-specific long-acting broadly neutralising antibodies (bNAbs) 3BNC117-LS and 10-1074-LS, which target CD4 binding site and V3 loop respectively, on post-treatment viral control.

METHODS:

RIO is a randomised, placebo-controlled, double-blinded prospective phase II study. Eligible individuals will have started ART within 3 months of primary HIV infection and have viral sequences that appear to be sensitive to both bNAbs. It will randomise 72 eligible participants 11 to the following arms via a two-stage design. In Stage 1, arm A participants are given dual long-acting (LS-variants) bNAbs infusions, followed by intensively monitored Analytical Treatment Interruption (ATI) (n = 36); in arm B, participants receive placebo infusions followed by ATI. The primary endpoint will be time to viral rebound within 36 weeks after ATI. Upon viral rebound, the participant and researcher are unblinded. Participants in arm A recommence ART and complete the study. Participants in arm B are invited to restart ART and enroll into Stage 2 where they will receive open-label LS bNAbs, followed by a second ATI 24 weeks after. Secondary and exploratory endpoints include adverse events, time to undetectable viraemia after restarting ART, immunological markers, HIV proviral DNA, serum bNAb concentrations in blood, bNAb resistance at viral rebound, and quality of life measures.

DISCUSSION:

The two-stage design was determined in collaboration with community involvement. This design allows all participants the option to receive bNAbs. It also tests the hypothesis that bNAbs may drive sustained HIV control beyond the duration of detectable bNAb concentrations. Community representatives were involved at all stages. This included the two-stage design, discussion on the criteria to restart ART, frequency of monitoring visits off ART, and reducing the risk of onward transmission to HIV-negative partners. It also included responding to the challenges of COVID-19. TRIAL REGISTRATION The protocol is registered on Clinical. TRIALS gov and EudraCT and has approval from UK Ethics and MHRA.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: HIV Infections / HIV-1 / COVID-19 Type of study: Controlled clinical trial / Diagnostic study / Clinical Practice Guide / Observational study / Randomized controlled trials / Risk factors Topics: Long Covid / Variants Limits: Humans Language: English Journal: Trials Journal subject: Medicine / Therapeutics Year: 2022 Document Type: Article Affiliation country: S13063-022-06151-w

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Full text: Available Collection: International databases Database: MEDLINE Main subject: HIV Infections / HIV-1 / COVID-19 Type of study: Controlled clinical trial / Diagnostic study / Clinical Practice Guide / Observational study / Randomized controlled trials / Risk factors Topics: Long Covid / Variants Limits: Humans Language: English Journal: Trials Journal subject: Medicine / Therapeutics Year: 2022 Document Type: Article Affiliation country: S13063-022-06151-w