Ex vivo sensitivity to broadly neutralizing antibodies and anti-CD4 antibody UB-421 of infectious viral isolates from people living with multidrug-resistant HIV

BACKGROUND

People living with HIV (PLWH) with multidrug-resistant (MDR) viruses have limited therapeutic options and present challenges regarding clinical management. Recent studies have shown that passive transfer of combination broadly neutralizing antibodies (bNAbs) against HIV and anti-domain 1 CD4 antibody UB-421 can sustain virologic suppression in PLWH in the absence of antiretroviral therapy (ART). Yet studies addressing the therapeutic potential of these antibodies and/or detailed characterization of immunologic and virologic parameters in PLWH with MDR HIV are lacking.

METHODS

We examined levels of immune activation and exhaustion markers on CD8+ T cells and the intact HIV proviral DNA burden in 11 PLWH with MDR viruses. For comparison purposes, we included a control group consisting of 27 ART-naïve viremic PLWH. In addition, we determined the sensitivity of infectious viral isolates obtained from the participants against eight bNAbs (3BNC117, 10-1074, VRC01, VRC07, N6, 10E8, PGDM1400, and PGT121) and two anti-CD4 antibodies (ibalizumab and UB-421) using a TZM-bl-based neutralization/suppression assay.

FINDINGS

The level of intact HIV proviral DNA was comparable between the two groups (P = 0.29). The levels of activation and exhaustion markers PD-1 (P = 0.0019), TIGIT (P = 0.0222), 2B4 (P = 0.0015), CD160 (P = 0.0015), and CD38+/HLA-DR+ (P = 0.0138) were significantly lower in the MDR group. The infectious viral isolates from each study participant with MDR HIV were resistant to at least 2 bNAbs; however, they were sensitive to at least one of the CD4-binding and non-CD4-binding site antibodies. The majority of participants had ibalizumab-sensitive viruses although the isolates from some participants showed reduced sensitivity to ibalizumab. Notably, none of the 93 viral isolates obtained from the participants were resistant to UB-421.

INTERPRETATION

Our data suggest that combination therapy with HIV-specific bNAbs and/or UB-421 in the presence of optimized background therapy could potentially provide sustained virologic suppression in PLWH with MDR HIV. However, this therapeutic strategy needs to be evaluated in human clinical trials.

FUNDING

Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health.

Immunologic and virologic parameters associated with HIV DNA reservoir size in people living with HIV receiving antiretroviral therapy

BACKGROUND

A better understanding of the dynamics of HIV reservoirs in CD4+ T cells of people with HIV (PWH) receiving antiretroviral therapy (ART) is crucial for developing therapies to eradicate the virus.

METHODS

We conducted a study involving 28 aviremic PWH receiving ART with high and low levels of HIV DNA. We analyzed immunologic and virologic parameters and their association with the HIV reservoir size.

RESULTS

The frequency of CD4+ T cells carrying HIV DNA was associated with higher pre-ART plasma viremia, lower pre-ART CD4+ T cell counts, and lower pre-ART CD4/CD8 ratios. During ART, the High group maintained elevated levels of intact HIV proviral DNA, cell-associated HIV RNA, and inducible virion-associated HIV RNA. HIV sequence analysis showed no evidence for preferential accumulation of defective proviruses nor higher frequencies of clonal expansion in the High versus Low group. Phenotypic and functional T-cell analyses did not show enhanced immune-mediated virologic control in the Low versus High group. Of considerable interest, pre-ART innate immunity was significantly higher in the Low versus High group.

CONCLUSIONS

Our data suggest that innate immunity at the time of ART initiation may play an important role in modulating the dynamics and persistence of viral reservoirs in PWH.

Impact of Monkeypox Virus Infection on Immune Parameters in a Woman With Human Immunodeficiency Virus Receiving Clinically Effective Antiretroviral Therapy

We describe the immunologic and virologic impact of monkeypox (mpox) infection in a woman with human immunodeficiency virus (HIV) whose plasma HIV viremia was suppressed by clinically effective antiretroviral therapy. Extensive phenotypic analyses of B and T cells in peripheral blood and biomarkers in plasma showed significant immunologic perturbations despite the presence of mild mpox disease. Dramatic shifts were noted in the frequencies of total B cells, plasmablasts, and plasmablast immunoglobulin isotypes. Flow cytometric analyses showed a dramatic increase in the frequency of CD38+HLA-DR+ CD8+ T cells after mpox infection. Our data offer guidance for future studies involving mpox infection in affected populations.

Effect of SARS-CoV-2 vaccine booster on HIV reservoirs and immune markers

We investigated effects of the SARV-CoV-2 booster vaccination on HIV reservoir size, immune markers, and host immune responses in PWH receiving ART. Our data suggest that the SARS-CoV-2 booster vaccine is not likely to replenish the persistent HIV reservoir nor provide an immunologic environment to facilitate active HIV expression/replication.

A Longitudinal Study of COVID-19 Sequelae and Immunity: Baseline Findings

BACKGROUND

A substantial proportion of persons who develop COVID-19 report persistent symptoms after acute illness. Various pathophysiologic mechanisms have been implicated in the pathogenesis of postacute sequelae of SARS-CoV-2 infection (PASC).

OBJECTIVE

To characterize medical sequelae and persistent symptoms after recovery from COVID-19 in a cohort of disease survivors and controls.

DESIGN

Cohort study. (ClinicalTrials.gov: NCT04411147).

SETTING

National Institutes of Health Clinical Center, Bethesda, Maryland.

PARTICIPANTS

Self-referred adults with laboratory-documented SARS-CoV-2 infection who were at least 6 weeks from symptom onset were enrolled regardless of presence of PASC. A control group comprised persons with no history of COVID-19 or serologic evidence of SARS-CoV-2 infection, recruited regardless of their current health status. Both groups were enrolled over the same period and from the same geographic area.

MEASUREMENTS

All participants had the same evaluations regardless of presence of symptoms, including physical examination, laboratory tests and questionnaires, cognitive function testing, and cardiopulmonary evaluation. A subset also underwent exploratory immunologic and virologic evaluations.

RESULTS

189 persons with laboratory-documented COVID-19 (12% of whom were hospitalized during acute illness) and 120 antibody-negative control participants were enrolled. At enrollment, symptoms consistent with PASC were reported by 55% of the COVID-19 cohort and 13% of control participants. Increased risk for PASC was noted in women and those with a history of anxiety disorder. Participants with findings meeting the definition of PASC reported lower quality of life on standardized testing. Abnormal findings on physical examination and diagnostic testing were uncommon. Neutralizing antibody levels to spike protein were negative in 27% of the unvaccinated COVID-19 cohort and none of the vaccinated COVID-19 cohort. Exploratory studies found no evidence of persistent viral infection, autoimmunity, or abnormal immune activation in participants with PASC.

LIMITATIONS

Most participants with COVID-19 had mild to moderate acute illness that did not require hospitalization. The prevalence of reported PASC was likely overestimated in this cohort because persons with PASC may have been more motivated to enroll. The study did not capture PASC that resolved before enrollment.

CONCLUSION

A high burden of persistent symptoms was observed in persons after COVID-19. Extensive diagnostic evaluation revealed no specific cause of reported symptoms in most cases. Antibody levels were highly variable after COVID-19.

PRIMARY FUNDING SOURCE

Division of Intramural Research, National Institute of Allergy and Infectious Diseases.

Combination anti-HIV antibodies provide sustained virological suppression

Antiretroviral therapy is highly effective in suppressing human immunodeficiency virus (HIV)1. However, eradication of the virus in individuals with HIV has not been possible to date2. Given that HIV suppression requires life-long antiretroviral therapy, predominantly on a daily basis, there is a need to develop clinically effective alternatives that use long-acting antiviral agents to inhibit viral replication3. Here we report the results of a two-component clinical trial involving the passive transfer of two HIV-specific broadly neutralizing monoclonal antibodies, 3BNC117 and 10-1074. The first component was a randomized, double-blind, placebo-controlled trial that enrolled participants who initiated antiretroviral therapy during the acute/early phase of HIV infection. The second component was an open-label single-arm trial that enrolled individuals with viraemic control who were naive to antiretroviral therapy. Up to 8 infusions of 3BNC117 and 10-1074, administered over a period of 24 weeks, were well tolerated without any serious adverse events related to the infusions. Compared with the placebo, the combination broadly neutralizing monoclonal antibodies maintained complete suppression of plasma viraemia (for up to 43 weeks) after analytical treatment interruption, provided that no antibody-resistant HIV was detected at the baseline in the study participants. Similarly, potent HIV suppression was seen in the antiretroviral-therapy-naive study participants with viraemia carrying sensitive virus at the baseline. Our data demonstrate that combination therapy with broadly neutralizing monoclonal antibodies can provide long-term virological suppression without antiretroviral therapy in individuals with HIV, and our experience offers guidance for future clinical trials involving next-generation antibodies with long half-lives.

Simplified guide for precise implant placement: a technical note

Ideal implant placement is ultimately determined by the requirements of the final restoration. For the surgeon placing implants, proper angulation, parallelism, and spacing are critical to the final restoration. The use of a stainless-steel drill guide sleeve in an acrylic resin surgical template can make it possible to achieve optimal placement. Communication between the restoring dentist, surgeon, and laboratory technician is enhanced by this system since dowel pins fit precisely into the sleeves and determine sleeve and, ultimately, implant position. This system allows the surgeon to negotiate bony irregularities and ramping defects with ease while preparing a more concentric implant site.

Personality and dental care utilization: findings from the VA longitudinal study

The personality traits of introversion/extraversion and neuroticism were investigated as determinants of the utilization of restorative dental care, controlling for socioeconomic status and restorative need. The VA Dental Longitudinal Study (DLS) provided information on the restorative treatment received by 593 healthy adult males during a 10-year period. Utilization of restorative services was measured by calculating the percentage of surfaces that needed and received treatment, as identified by the DLS examiners by clinical and radiographic examination. Oral examinations were initiated in 1969 with subsequent examinations occurring at approximately 3-year intervals. Personality measures for these individuals were obtained using the EPI-Q, a shortened form of the Eysenck Personality Inventory. A plot of neuroticism versus the utilization measure yielded a curvilinear relationship suggesting that participants seeking the most dental care scored moderately on the neuroticism scale while those scoring lowest and highest on this scale sought less treatment. In contrast, the introversion/extraversion scale showed no apparent relationship with dental care utilization. Results from the regression analysis suggest that dentition and socioeconomic status are strong determinants of utilization and that need for restorative treatment influences utilization.

Suction assisted lipectomy of the face and neck

A method of suction assisted lipectomy of the face and neck is presented as a preferable alternative to sharp, direct excision of such fat. Complications and results are discussed.

Suction assisted lipectomy of the face and neck

A method of suction assisted lipectomy of the face and neck is presented as a preferable alternative to sharp, direct excision of such fat. Complications and results are discussed.