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La terapia combinada con anticuerpos anti-VIH-1 mantiene la supresión viral
Pilar Mendoza1, Henning Gruell2,3,4, Lilian Nogueira1
1Laboratory of Molecular Immunology, The Rockefeller University, New York, NY, USA.
Nature
|September 28, 2018
Resumen
Dos anticuerpos ampliamente neutralizantes, 3BNC117 y 10-1074, fueron probados en un ensayo clínico para la interrupción del tratamiento del VIH-1. Esta combinación de anticuerpos suprimió con éxito el VIH-1 en los participantes sin tratamiento antirretroviral.
Área de la Ciencia:
- Inmunología
- Virología
- Medicina Clínica
Sus antecedentes:
- La terapia antirretroviral (TAR) es esencial para el tratamiento de la infección por VIH-1 debido al rápido rebote viral tras la interrupción del tratamiento.
- Los anticuerpos ampliamente neutralizantes (bNAbs) ofrecen una alternativa potencial o un complemento al TARV para el control del VIH-1.
- Comprender la eficacia de las combinaciones de bNAb durante la interrupción del tratamiento es crucial para desarrollar nuevas estrategias terapéuticas para el VIH-1.
Objetivo del estudio:
- Evaluar la seguridad y eficacia de un tratamiento combinado con dos bNAbs, 3BNC117 y 10-1074, durante la interrupción analítica del tratamiento (ATI) en individuos con VIH-1.
- Evaluar la duración de la supresión viral y el surgimiento de la resistencia viral en los participantes que recibieron infusiones de bNAb en lugar de ART.
Principales métodos:
- Se realizó un ensayo clínico de fase 1b en el que participaron nueve personas con VIH-1.
- Los participantes recibieron tres infusiones de una combinación de 3BNC117 y 10-1074 anticuerpos (30 mg/ kg cada uno) a las semanas 0, 3 y 6 durante la ITA.
- La carga viral, la resistencia a los anticuerpos y la seguridad fueron monitoreadas durante todo el período del estudio.
Principales resultados:
- La combinación de 3BNC117 y 10-1074 fue generalmente bien tolerada.
- Los nueve participantes con reservas virales latentes sensibles a los anticuerpos mantuvieron la supresión viral durante una mediana de 21 semanas (rango: 15 a > 30 semanas).
- Ninguno de los participantes desarrolló resistencia al VIH-1 tanto al 3BNC117 como al 10-1074.
Conclusiones:
- La combinación de anticuerpos monoclonales contra el VIH-1 3BNC117 y 10-1074 puede mantener eficazmente la supresión viral a largo plazo en ausencia de TARV.
- Esta combinación de bNAb representa una estrategia prometedora para el tratamiento del VIH-1, particularmente en personas con reservas virales susceptibles.
- Se requiere más investigación para explorar la durabilidad a largo plazo y el potencial de este enfoque basado en anticuerpos para la remisión del VIH-1.
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