HIV-1 Infection
Conditions
Brief summary
The study was done to: * Start antiretroviral therapy (ART) early in those recently or acutely infected with HIV-1 * See how starting ART as soon as the infection is found affects the amount of HIV-1 in blood and how well the body fights the HIV-1 infection * Look at the amount of HIV-1 DNA (genetic material for HIV-1) seen in CD4+ T-cells (infection-fighting cells in blood) after 48 weeks of ART * See how early treatment for HIV affects the numbers of HIV-1 infection fighting cells (CD4+ and CD8+ T-cells) in blood
Detailed description
This was a Phase II, prospective, open-label two-step study to measure the effects of early ART on the establishment of HIV-1 reservoir and HIV-1-specific immunity. Participants were enrolled if they fulfilled the inclusion criteria for acute HIV-1 infection (AHI) diagnosis within 7 days prior to entry and had an enrollment visit with the immediate initiation of ART. Plasma and serum samples for Fiebig staging were collected at the time of ART initiation. Participants were followed for up to 216 weeks (72 weeks on Step 1 and 144 weeks on Step 2). Evaluations at weeks 2 and 8 on Step 1 were performed via telephone. The Fiebig stage-classification system was used to characterize the progression from HIV-1 exposure to HIV-1 seroconversion at the time of ART initiation. In this study, the five Fiebig stages of interest were simplified into three study groups as described below (based on HIV-1 antibody diagnostic profile at time of ART initiation). The primary analysis was based on Step 1. Step 2 was added to the study for long term follow-up. The rationale for the extended follow-up period was to expand the number of available participants for future therapeutic and cure studies without the burden of frequent visits and the cost of study-provided laboratory testing. Group 1: Fiebig I/II (non-reactive HIV-1 antibody) Group 2: Fiebig III/IV (reactive HIV-1 antibody and negative or indeterminate results on the Western Blot (WB) or Geenius HIV-1/HIV-2) Group 3: Fiebig V (reactive HIV-1 antibody and positive WB or Geenius HIV-1/HIV-2 without p31 band) Although participants in Fiebig VI (positive WB or Geenius HIV-1/HIV-2 with p31 band) were not specifically targeted for enrollment in this study, it was possible that a small number of participants would be determined to be in Fiebig VI (positive Western blot or Geenius HIV-1/HIV-2 with p31 band) based on analysis of the entry samples. Participants who were determined to be in Fiebig VI were followed on the study for no more than 24 weeks on Step 1, allowing ample time for them to pursue alternative sources for ART. Enrolled participants without HIV or in Fiebig VI were replaced. The study-provided regimen was single tablet regimen elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (EVG/COBI/FTC/TAF) or bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF). Other non-study-provided antiretroviral (ARV) regimens were also allowed for participants who were pregnant, breastfeeding, or unable/unwilling to take EVG/COBI/FTC/TAF or BIC/FTC/TAF, or for participants whose local health care/primary care provider preferred starting a different initial ARV regimen.
Interventions
DRUGelvitegravir/cobicistat/emtricitabine/tenofovir alafenamide or bictegravir/emtricitabine/tenofovir alafenamide or other medically-appropriate FDA-approved antiretroviral therapy
Participants received one tablet of elvitegravir 150mg/cobicistat 150mg/emtricitabine 200mg/tenofovir alafenamide 10mg by mouth daily with food or one tablet of bictegravir 50mg/emtricitabine 200mg/tenofovir alafenamide 25mg by mouth daily with or without food. Other non-study-provided ARV regimens were allowed for participants who were pregnant, breastfeeding, or unable/unwilling to take EVG/COBI/FTC/TAF or BIC/FTC/TAF, or for participants whose local health care/primary care provider preferred starting a different initial ARV regimen.
Sponsors
National Institute of Allergy and Infectious Diseases (NIAID)
Advancing Clinical Therapeutics Globally for HIV/AIDS and Other Infections
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Appropriate documentation from medical records of diagnosis of acute HIV-1 infection (AHI) within 7 days prior to enrollment, that includes one of the following: 1. A detectable HIV-1 RNA within 28 days prior to study entry AND a non-reactive HIV-1 antibody within 7 days prior to entry OR 2. A detectable HIV-1 RNA or a reactive HIV-1 antibody within 28 days prior to study entry AND a negative/indeterminate WB or negative/indeterminate Geenius HIV-1/HIV-2 Supplemental Assay within 7 days prior to entry OR 3. A documented non-reactive HIV-1 antibody or negative HIV-1 RNA within 90 days prior to study entry AND a documented reactive HIV-1 antibody or positive WB that is negative for p31 band or a positive Geenius HIV-1/HIV-2 Supplemental Assay that is negative for p31 band within 7 days prior to entry OR 4. ARCHITECT or GSCOMBO S/CO ≥10 within 7 days prior to entry AND a non-reactive HIV-1 antibody within 7 days prior to entry OR 5. ARCHITECT or GSCOMBO S/CO ≥1 within 7 days prior to entry AND a non-reactive HIV-1 antibody within 7 days prior to entry AND a known prior S/CO \<0.5 within 90 days prior to entry OR 6. ARCHITECT or GSCOMBO S/CO \>0.5 but \<10 within 7 days prior to entry AND a non-reactive HIV-1 antibody within 7 days prior to entry AND detectable HIV-1 RNA within 7 days prior to entry Note A: HIV-1 RNA result must be reported from an FDA-approved or CE-marked assay. Note B: Since characterization of Fiebig stage using samples at the time of ART initiation was performed with results known within 12 weeks based on standardized, centralized testing, an estimated Fiebig group at enrollment based on inclusion criteria as shown in the table above will provide additional real-time monitoring for accruals into each study group. * Ability and willingness of candidate to provide written informed consent. * Ability and willingness to initiate ART at enrollment. * Ability and willingness to participate in scheduled study visits for up to 72 weeks. * Female candidates of reproductive potential who are not pregnant at the time of enrollment and who will receive the study-provided EVG/COBI/FTC/TAF and must agree not to participate in the conception process (ie, active attempt to become pregnant, in vitro fertilization), and if participating in sexual activity that could lead to pregnancy, the female candidate must agree to use at least one reliable form of contraceptive while receiving study-provided treatment. Female candidates are considered to be of reproductive potential if any of the following conditions apply: * Candidate has experienced menarche. * Candidate has not undergone bilateral tubal ligation, bilateral oophorectomy, or hysterectomy. * Candidate has not experienced menopause, defined as lack of menstruation within the preceding 12 months. Acceptable contraceptive methods include: * Condoms (male or female) with or without a spermicidal agent * Diaphragm or cervical cap with spermicide * Intrauterine device * Hormonal contraceptive Female candidates who are not of reproductive potential or whose male partner(s) has documented azoospermia are not required to use contraceptives. Any statement of self-reported sterility or that of her partner must be entered in the source documents. NOTE: Acceptable documentation of lack of reproductive potential is oral or written documentation from the individual. Female candidates who are prescribed a non-study-provided ARV regimen should discuss the safety of that regimen during conception and pregnancy with the prescribing physician. Such individuals should follow medical guidance regarding any potential need for contraception while using the non-study-provided ARV regimen. Note: Pregnant and breastfeeding women may enroll in the study provided that they meet the eligibility requirements and have access to non-study-provided ARV regimens.
Exclusion criteria
* Positive HIV-1 antibody test ≥90 days prior to study entry. * Active drug or alcohol use or dependence that, in the opinion of the site investigator, would interfere with adherence to study requirements. * Any acute, chronic, or recent and clinically significant medical condition that, in the opinion of the site investigator, would interfere with adherence to study requirements or jeopardize the safety or rights of the participant. * Receipt of an investigational study agent within 28 days prior to enrollment * Chronic or recurrent use of medications that modify host immune response, eg, oral or parenteral steroids, cancer chemotherapy. * AHI diagnosis within 60 days after receiving any investigational ARV or HIV-1 vaccine or immune prophylaxis for HIV-1 infection. * Use of ARVs for pre- or post-exposure prophylaxis within 60 days prior to the diagnosis of AHI.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of Participants With Undetectable Cell-associated HIV-1 DNA (CAHD) | At week 48 | Proportion of participants with 0 copies of CAHD per 5 million CD4+ blood-derived CD4+ T-cells (assayed by quantitative polymerase chain reaction \[qPCR\]), assessed separately and jointly by integrase and gag assays. In order for a participant to be considered as having 0 copies of CAHD for joint assays, the participant must be found to have an undetectable CAHD result from both integrase and gag assays. If all participants in both arms had undetectable CAHD then the statistical test was not performed. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| HIV-1-specific CD4+ and T-cell Responses to Nef, Gag, Pol and Env by Flow Cytometry | At week 48 | Percent of HIV-1-specific CD4+ T-cells expressing any cytokine/marker (CD40L, CD107a, IFNg, MIP1B, TNFa) to each of the 4 protein stimulants (nef, gag, pol and env) by flow cytometry while HIV-1 RNA is suppressed on ART. The results for a specific participant are calculated by subtracting the corresponding background control value (media control). If the result would be less than zero after background subtraction, the result was set to zero. Cytokine/Marker Names: CD40 ligand (CD40L); Cluster of Differentiation 107a (CD107a); Interferon gamma (IFNg); Macrophage Inflammatory Protein beta (MIP1B); Tumor Necrosis Factor alpha (TNFa) |
| HIV-1-specific CD8+ and T-cell Responses to Nef, Gag, Pol and Env by Flow Cytometry | At 48 weeks | Percent of HIV-1-specific CD8+ T-cells expressing any cytokine/marker (CD40L, CD107a, IFNg, MIP1B, TNFa) to each of the 4 protein stimulants (nef, gag, pol and env) by flow cytometry while HIV-1 RNA is suppressed on ART. The results for a specific participant are calculated by subtracting the corresponding background control value (media control). If the result would be less than zero after background subtraction, the result was set to zero. Cytokine/Marker Names: CD40 ligand (CD40L); Cluster of Differentiation 107a (CD107a); Interferon gamma (IFNg); Macrophage Inflammatory Protein beta (MIP1B); Tumor Necrosis Factor alpha (TNFa) |
| Proportion of Participants With Undetectable Cell-associated HIV-1 DNA (CAHD) Prior to ART Initiation | At week 0 | Proportion of participants with 0 copies of CAHD per million CD4+ blood-derived CD4+ T-cells (assayed by quantitative PCR \[qPCR\]), assessed separately and jointly by integrase and gag assays. In order for a participant to be considered as having 0 copies of CAHD for joint assays, the participant must be found to have an undetectable CAHD result from both integrase and gag assays. If all participants in both arms had undetectable CAHD then the statistical test was not performed. |
Countries
Brazil, Malawi, Peru, Thailand, United States, Zimbabwe
Participant flow
Recruitment details
Participants were enrolled from January 2017 to December 2019 at 30 sites in Brazil, Malawi, Peru, Thailand, United States, and Zimbabwe.
Pre-assignment details
There was no randomization in this study. Participants who were determined to be in Fiebig VI were followed on the study for no more than 24 weeks on Step 1. Confirmed Fiebig VI and HIV negative participants were replaced.
Participants by arm
| Arm | Count |
|---|---|
| Arm 1: Fiebig I/II Participants enrolled during Fiebig stages I or II (non-reactive HIV-1 antibody).
elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide or bictegravir/emtricitabine/tenofovir alafenamide or other medically-appropriate FDA-approved antiretroviral therapy: Participants received one tablet of elvitegravir 150mg/cobicistat 150mg/emtricitabine 200mg/tenofovir alafenamide 10mg by mouth daily with food or one tablet of bictegravir 50mg/emtricitabine 200mg/tenofovir alafenamide 25mg by mouth daily with or without food. Other non-study-provided ARV regimens were allowed for participants who were pregnant, breastfeeding, or unable/unwilling to take EVG/COBI/FTC/TAF or BIC/FTC/TAF, or for participants whose local health care/primary care provider preferred starting a different initial ARV regimen. | 49 |
| Arm 2: Fiebig III/IV Participants enrolled during Fiebig stages III or IV (reactive HIV-1 antibody and negative or indeterminate results on the Western blot or Geenius HIV-1/HIV-2).
elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide or bictegravir/emtricitabine/tenofovir alafenamide or other medically-appropriate FDA-approved antiretroviral therapy: Participants received one tablet of elvitegravir 150mg/cobicistat 150mg/emtricitabine 200mg/tenofovir alafenamide 10mg by mouth daily with food or one tablet of bictegravir 50mg/emtricitabine 200mg/tenofovir alafenamide 25mg by mouth daily with or without food. Other non-study-provided ARV regimens were allowed for participants who were pregnant, breastfeeding, or unable/unwilling to take EVG/COBI/FTC/TAF or BIC/FTC/TAF, or for participants whose local health care/primary care provider preferred starting a different initial ARV regimen. | 79 |
| Arm 3: Fiebig V Participants enrolled during Fiebig stage V (reactive HIV-1 antibody and positive Western blot or Geenius HIV-1/HIV-2 without p31 band).
elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide or bictegravir/emtricitabine/tenofovir alafenamide or other medically-appropriate FDA-approved antiretroviral therapy: Participants received one tablet of elvitegravir 150mg/cobicistat 150mg/emtricitabine 200mg/tenofovir alafenamide 10mg by mouth daily with food or one tablet of bictegravir 50mg/emtricitabine 200mg/tenofovir alafenamide 25mg by mouth daily with or without food. Other non-study-provided ARV regimens were allowed for participants who were pregnant, breastfeeding, or unable/unwilling to take EVG/COBI/FTC/TAF or BIC/FTC/TAF, or for participants whose local health care/primary care provider preferred starting a different initial ARV regimen. | 60 |
| Fiebig VI Participants enrolled during Fiebig stage VI (reactive HIV-1 antibody and positive Western blot or Geenius HIV-1/HIV-2 without p31 band).
elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide or bictegravir/emtricitabine/tenofovir alafenamide or other medically-appropriate FDA-approved antiretroviral therapy: Participants received one tablet of elvitegravir 150mg/cobicistat 150mg/emtricitabine 200mg/tenofovir alafenamide 10mg by mouth daily with food or one tablet of bictegravir 50mg/emtricitabine 200mg/tenofovir alafenamide 25mg by mouth daily with or without food. Other non-study-provided ARV regimens were allowed for participants who were pregnant, breastfeeding, or unable/unwilling to take EVG/COBI/FTC/TAF or BIC/FTC/TAF, or for participants whose local health care/primary care provider preferred starting a different initial ARV regimen. | 4 |
| HIV-negative Participants found to be HIV negative following the results of HIV-1 RNA testing at study entry. No study treatment. | 3 |
| Total | 195 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 | FG004 |
|---|---|---|---|---|---|---|
| Step 1 | Did Not Return to Clinic | 2 | 3 | 4 | 0 | 0 |
| Step 1 | Had to Interrupt antiretroviral (ARV) | 1 | 0 | 0 | 0 | 0 |
| Step 1 | Incarceration | 0 | 1 | 0 | 0 | 0 |
| Step 1 | Lost to Follow-up | 1 | 3 | 3 | 0 | 0 |
| Step 1 | Moved | 0 | 1 | 1 | 0 | 0 |
| Step 1 | Non-Adherence to Study Drug | 2 | 0 | 1 | 0 | 0 |
| Step 1 | Non-Adherence to Study Requirements | 3 | 1 | 0 | 0 | 0 |
| Step 1 | Not Eligible | 0 | 0 | 0 | 0 | 3 |
| Step 1 | Virologic Failure | 2 | 1 | 1 | 0 | 0 |
| Step 1 | Withdrawal By Participant | 1 | 2 | 1 | 0 | 0 |
| Step 2 | Death | 1 | 0 | 0 | 0 | 0 |
| Step 2 | Incarceration | 0 | 0 | 1 | 0 | 0 |
| Step 2 | Lost to Follow-up | 3 | 3 | 1 | 0 | 0 |
| Step 2 | Unexpected Closure of Site | 0 | 1 | 1 | 0 | 0 |
| Step 2 | Withdrawal by Subject | 0 | 1 | 1 | 0 | 0 |
Baseline characteristics
| Characteristic | Arm 2: Fiebig III/IV | Arm 1: Fiebig I/II | Total | HIV-negative | Fiebig VI | Arm 3: Fiebig V |
|---|---|---|---|---|---|---|
| Age, Continuous | 30 years | 26 years | 27 years | 25 years | 36 years | 26 years |
| Age, Customized 18-29 years | 39 Participants | 31 Participants | 110 Participants | 2 Participants | 2 Participants | 36 Participants |
| Age, Customized 30-39 years | 18 Participants | 12 Participants | 43 Participants | 1 Participants | 0 Participants | 12 Participants |
| Age, Customized 40-49 years | 12 Participants | 4 Participants | 24 Participants | 0 Participants | 2 Participants | 6 Participants |
| Age, Customized 50+ years | 10 Participants | 2 Participants | 18 Participants | 0 Participants | 0 Participants | 6 Participants |
| BMI | 25.9 kg/m^2 | 22.5 kg/m^2 | 24.0 kg/m^2 | 23.2 kg/m^2 | 22.7 kg/m^2 | 23.8 kg/m^2 |
| CD4 Count | 383 cells per mm^3 | 348 cells per mm^3 | 406 cells per mm^3 | 1090 cells per mm^3 | 436 cells per mm^3 | 490 cells per mm^3 |
| CD8 Count | 544 cells per mm^3 | 322 cells per mm^3 | 613 cells per mm^3 | 474 cells per mm^3 | 1401 cells per mm^3 | 1016 cells per mm^3 |
| Cell-associated HIV-1 DNA Gag Assay | 6357 copies per 5 million CD4+ T-cells | 4455 copies per 5 million CD4+ T-cells | 5586 copies per 5 million CD4+ T-cells | 0 copies per 5 million CD4+ T-cells | 3990 copies per 5 million CD4+ T-cells | 5388 copies per 5 million CD4+ T-cells |
| Cell-associated HIV-1 DNA Integrase Assay | 15440 copies per 5 million CD4+ T-cells | 7739 copies per 5 million CD4+ T-cells | 10507 copies per 5 million CD4+ T-cells | 0 copies per 5 million CD4+ T-cells | 4575 copies per 5 million CD4+ T-cells | 10104 copies per 5 million CD4+ T-cells |
| Ethnicity (NIH/OMB) Hispanic or Latino | 30 Participants | 17 Participants | 68 Participants | 2 Participants | 1 Participants | 18 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 48 Participants | 32 Participants | 126 Participants | 1 Participants | 3 Participants | 42 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 1 Participants | 0 Participants | 1 Participants | 0 Participants | 0 Participants | 0 Participants |
| HIV-1 RNA >= 10,000,000 copies per mL | 21 Participants | 13 Participants | 39 Participants | 0 Participants | 1 Participants | 4 Participants |
| HIV-1 RNA 1,000,000 - <10,000,000 copies per mL | 39 Participants | 17 Participants | 72 Participants | 0 Participants | 0 Participants | 16 Participants |
| HIV-1 RNA 100,000 - <1,000,000 copies per mL | 13 Participants | 9 Participants | 46 Participants | 0 Participants | 1 Participants | 23 Participants |
| HIV-1 RNA 10,000 - <100,000 copies per mL | 4 Participants | 9 Participants | 24 Participants | 0 Participants | 1 Participants | 10 Participants |
| HIV-1 RNA 1000 - <10,000 copies per mL | 2 Participants | 0 Participants | 8 Participants | 0 Participants | 0 Participants | 6 Participants |
| HIV-1 RNA 40 - <1000 copies per mL | 0 Participants | 1 Participants | 1 Participants | 0 Participants | 0 Participants | 0 Participants |
| HIV-1 RNA <40 copies per mL | 0 Participants | 0 Participants | 5 Participants | 3 Participants | 1 Participants | 1 Participants |
| HIV-1 RNA (log10 copies per mL) | 6.5 log10(copies per mL) | 6.4 log10(copies per mL) | 6.2 log10(copies per mL) | 1.6 log10(copies per mL) | 5.0 log10(copies per mL) | 5.4 log10(copies per mL) |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 1 Participants | 12 Participants | 14 Participants | 0 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Black or African American | 35 Participants | 19 Participants | 97 Participants | 1 Participants | 3 Participants | 39 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 1 Participants | 0 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 7 Participants | 4 Participants | 17 Participants | 2 Participants | 0 Participants | 4 Participants |
| Race (NIH/OMB) White | 36 Participants | 14 Participants | 66 Participants | 0 Participants | 0 Participants | 16 Participants |
| Region of Enrollment Brazil | 10 Participants | 6 Participants | 25 Participants | 0 Participants | 1 Participants | 8 Participants |
| Region of Enrollment Malawi | 3 Participants | 4 Participants | 11 Participants | 1 Participants | 0 Participants | 3 Participants |
| Region of Enrollment Peru | 0 Participants | 2 Participants | 5 Participants | 2 Participants | 0 Participants | 1 Participants |
| Region of Enrollment Thailand | 1 Participants | 12 Participants | 13 Participants | 0 Participants | 0 Participants | 0 Participants |
| Region of Enrollment United States | 65 Participants | 25 Participants | 133 Participants | 0 Participants | 1 Participants | 42 Participants |
| Region of Enrollment Zimbabwe | 0 Participants | 0 Participants | 8 Participants | 0 Participants | 2 Participants | 6 Participants |
| Sex: Female, Male Female | 12 Participants | 4 Participants | 30 Participants | 1 Participants | 2 Participants | 11 Participants |
| Sex: Female, Male Male | 67 Participants | 45 Participants | 165 Participants | 2 Participants | 2 Participants | 49 Participants |
| Sex/Gender, Customized Cisgender | 73 Participants | 47 Participants | 186 Participants | 2 Participants | 4 Participants | 60 Participants |
| Sex/Gender, Customized Not Reported | 1 Participants | 1 Participants | 3 Participants | 1 Participants | 0 Participants | 0 Participants |
| Sex/Gender, Customized Transgender Spectrum | 5 Participants | 1 Participants | 6 Participants | 0 Participants | 0 Participants | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk | EG005 affected / at risk | EG006 affected / at risk | EG007 affected / at risk |
|---|---|---|---|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 49 | 0 / 79 | 0 / 60 | 0 / 4 | 0 / 3 | 1 / 26 | 0 / 42 | 0 / 23 |
| other Total, other adverse events | 48 / 49 | 67 / 79 | 50 / 60 | 4 / 4 | 2 / 3 | 18 / 26 | 30 / 42 | 15 / 23 |
| serious Total, serious adverse events | 5 / 49 | 7 / 79 | 4 / 60 | 0 / 4 | 0 / 3 | 6 / 26 | 4 / 42 | 3 / 23 |
Outcome results
Primary
Proportion of Participants With Undetectable Cell-associated HIV-1 DNA (CAHD)
Proportion of participants with 0 copies of CAHD per 5 million CD4+ blood-derived CD4+ T-cells (assayed by quantitative polymerase chain reaction \[qPCR\]), assessed separately and jointly by integrase and gag assays. In order for a participant to be considered as having 0 copies of CAHD for joint assays, the participant must be found to have an undetectable CAHD result from both integrase and gag assays. If all participants in both arms had undetectable CAHD then the statistical test was not performed.
Time frame: At week 48
Population: Participants who maintained HIV-1 RNA\<50 copies/mL at week 48 with no ART interruption of 7 or more consecutive days, no prior virologic failure (defined as having two consecutive HIV-1 RNA \>200 copies/mL at week 24 or later or at any time after achieving HIV-1 RNA \<50 copies/mL ), had available CAHD results from week 48 or week 49, and were enrolled during Fiebig Stage I-V.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Arm 1: Fiebig I/II | Proportion of Participants With Undetectable Cell-associated HIV-1 DNA (CAHD) | Integrase Assay | 0.10 Proportion of participants |
| Arm 1: Fiebig I/II | Proportion of Participants With Undetectable Cell-associated HIV-1 DNA (CAHD) | Joint Assay (Integrase + Gag) | 0.00 Proportion of participants |
| Arm 1: Fiebig I/II | Proportion of Participants With Undetectable Cell-associated HIV-1 DNA (CAHD) | Gag Assay | 0.03 Proportion of participants |
| Arm 2: Fiebig III/IV | Proportion of Participants With Undetectable Cell-associated HIV-1 DNA (CAHD) | Integrase Assay | 0.06 Proportion of participants |
| Arm 2: Fiebig III/IV | Proportion of Participants With Undetectable Cell-associated HIV-1 DNA (CAHD) | Joint Assay (Integrase + Gag) | 0.00 Proportion of participants |
| Arm 2: Fiebig III/IV | Proportion of Participants With Undetectable Cell-associated HIV-1 DNA (CAHD) | Gag Assay | 0.02 Proportion of participants |
| Arm 3: Fiebig V | Proportion of Participants With Undetectable Cell-associated HIV-1 DNA (CAHD) | Joint Assay (Integrase + Gag) | 0.00 Proportion of participants |
| Arm 3: Fiebig V | Proportion of Participants With Undetectable Cell-associated HIV-1 DNA (CAHD) | Gag Assay | 0.00 Proportion of participants |
| Arm 3: Fiebig V | Proportion of Participants With Undetectable Cell-associated HIV-1 DNA (CAHD) | Integrase Assay | 0.10 Proportion of participants |
Comparison: Results from Integrase Assay. Null Hypothesis: There is no difference between Arm 1 and Arm 2 in the proportion of participants with undetectable CA-DNA.p-value: 0.48Fisher Exact
Comparison: Results from Integrase Assay. Null Hypothesis: There is no difference between Arm 1 and Arm 3 in the proportion of participants with undetectable CA-DNA.p-value: 1Fisher Exact
Comparison: Results from Integrase Assay. Null Hypothesis: There is no difference between Arm 2 and Arm 3 in the proportion of participants with undetectable CA-DNA.p-value: 0.5Fisher Exact
Comparison: Results from Gag Assay. Null Hypothesis: There is no difference between Arm 1 and Arm 2 in the proportion of participants with undetectable CA-DNA.p-value: 1Fisher Exact
Comparison: Results from Gag Assay. Null Hypothesis: There is no difference between Arm 1 and Arm 3 in the proportion of participants with undetectable CA-DNA.p-value: 0.44Fisher Exact
Comparison: Results from Gag Assay. Null Hypothesis: There is no difference between Arm 2 and Arm 3 in the proportion of participants with undetectable CA-DNA.p-value: 1Fisher Exact
Secondary
HIV-1-specific CD4+ and T-cell Responses to Nef, Gag, Pol and Env by Flow Cytometry
Percent of HIV-1-specific CD4+ T-cells expressing any cytokine/marker (CD40L, CD107a, IFNg, MIP1B, TNFa) to each of the 4 protein stimulants (nef, gag, pol and env) by flow cytometry while HIV-1 RNA is suppressed on ART. The results for a specific participant are calculated by subtracting the corresponding background control value (media control). If the result would be less than zero after background subtraction, the result was set to zero. Cytokine/Marker Names: CD40 ligand (CD40L); Cluster of Differentiation 107a (CD107a); Interferon gamma (IFNg); Macrophage Inflammatory Protein beta (MIP1B); Tumor Necrosis Factor alpha (TNFa)
Time frame: At week 48
Population: Participants who maintained HIV-1 RNA\<50 copies/mL at week 48 with no ART interruption of 7 or more consecutive days, no prior virologic failure (defined as having two consecutive HIV-1 RNA \>200 copies/mL at week 24 or later or at any time after achieving HIV-1 RNA \<50 copies/mL ), had available CAHD results from week 48 or week 49, had available immunology marker results where active control result is greater than or equal to the media control, and were enrolled during Fiebig Stage I-V.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Arm 1: Fiebig I/II | HIV-1-specific CD4+ and T-cell Responses to Nef, Gag, Pol and Env by Flow Cytometry | CD4+ T-cell Response to Env | 0.00 Percentage of CD4+ T-cells |
| Arm 1: Fiebig I/II | HIV-1-specific CD4+ and T-cell Responses to Nef, Gag, Pol and Env by Flow Cytometry | CD4+ T-cell Response to Gag | 0.06 Percentage of CD4+ T-cells |
| Arm 1: Fiebig I/II | HIV-1-specific CD4+ and T-cell Responses to Nef, Gag, Pol and Env by Flow Cytometry | CD4+ T-cell Response to Nef | 0.04 Percentage of CD4+ T-cells |
| Arm 1: Fiebig I/II | HIV-1-specific CD4+ and T-cell Responses to Nef, Gag, Pol and Env by Flow Cytometry | CD4+ T-cell Response to Pol | 0.00 Percentage of CD4+ T-cells |
| Arm 2: Fiebig III/IV | HIV-1-specific CD4+ and T-cell Responses to Nef, Gag, Pol and Env by Flow Cytometry | CD4+ T-cell Response to Pol | 0.04 Percentage of CD4+ T-cells |
| Arm 2: Fiebig III/IV | HIV-1-specific CD4+ and T-cell Responses to Nef, Gag, Pol and Env by Flow Cytometry | CD4+ T-cell Response to Env | 0.00 Percentage of CD4+ T-cells |
| Arm 2: Fiebig III/IV | HIV-1-specific CD4+ and T-cell Responses to Nef, Gag, Pol and Env by Flow Cytometry | CD4+ T-cell Response to Nef | 0.10 Percentage of CD4+ T-cells |
| Arm 2: Fiebig III/IV | HIV-1-specific CD4+ and T-cell Responses to Nef, Gag, Pol and Env by Flow Cytometry | CD4+ T-cell Response to Gag | 0.19 Percentage of CD4+ T-cells |
| Arm 3: Fiebig V | HIV-1-specific CD4+ and T-cell Responses to Nef, Gag, Pol and Env by Flow Cytometry | CD4+ T-cell Response to Pol | 0.04 Percentage of CD4+ T-cells |
| Arm 3: Fiebig V | HIV-1-specific CD4+ and T-cell Responses to Nef, Gag, Pol and Env by Flow Cytometry | CD4+ T-cell Response to Gag | 0.14 Percentage of CD4+ T-cells |
| Arm 3: Fiebig V | HIV-1-specific CD4+ and T-cell Responses to Nef, Gag, Pol and Env by Flow Cytometry | CD4+ T-cell Response to Nef | 0.10 Percentage of CD4+ T-cells |
| Arm 3: Fiebig V | HIV-1-specific CD4+ and T-cell Responses to Nef, Gag, Pol and Env by Flow Cytometry | CD4+ T-cell Response to Env | 0.08 Percentage of CD4+ T-cells |
Comparison: Null Hypothesis: There is no difference between Arm 1 and Arm 2 in percentage of HIV-1-specific CD4+ T-cells expressing any cytokine (CD40L, CD107a, IFNg, MIP1B, TNFa) in response to Env protein stimulant.p-value: 0.39Wilcoxon (Mann-Whitney)
Comparison: Null Hypothesis: There is no difference between Arm 1 and Arm 3 in percentage of HIV-1-specific CD4+ T-cells expressing any cytokine (CD40L, CD107a, IFNg, MIP1B, TNFa) in response to Env protein stimulant.p-value: 0.46Wilcoxon (Mann-Whitney)
Comparison: Null Hypothesis: There is no difference between Arm 2 and Arm 3 in percentage of HIV-1-specific CD4+ T-cells expressing any cytokine (CD40L, CD107a, IFNg, MIP1B, TNFa) in response to Env protein stimulant.p-value: 0.056Wilcoxon (Mann-Whitney)
Comparison: Null Hypothesis: There is no difference between Arm 1 and Arm 2 in percentage of HIV-1-specific CD4+ T-cells expressing any cytokine (CD40L, CD107a, IFNg, MIP1B, TNFa) in response to Gag protein stimulant.p-value: 0.025Wilcoxon (Mann-Whitney)
Comparison: Null Hypothesis: There is no difference between Arm 1 and Arm 3 in percentage of HIV-1-specific CD4+ T-cells expressing any cytokine (CD40L, CD107a, IFNg, MIP1B, TNFa) in response to Gag protein stimulant.p-value: 0.072Wilcoxon (Mann-Whitney)
Comparison: Null Hypothesis: There is no difference between Arm 2 and Arm 3 in percentage of HIV-1-specific CD4+ T-cells expressing any cytokine (CD40L, CD107a, IFNg, MIP1B, TNFa) in response to Gag protein stimulant.p-value: 0.47Wilcoxon (Mann-Whitney)
Comparison: Null Hypothesis: There is no difference between Arm 1 and Arm 2 in percentage of HIV-1-specific CD4+ T-cells expressing any cytokine (CD40L, CD107a, IFNg, MIP1B, TNFa) in response to Nef protein stimulant.p-value: 0.086Wilcoxon (Mann-Whitney)
Comparison: Null Hypothesis: There is no difference between Arm 1 and Arm 3 in percentage of HIV-1-specific CD4+ T-cells expressing any cytokine (CD40L, CD107a, IFNg, MIP1B, TNFa) in response to Nef protein stimulant.p-value: 0.18Wilcoxon (Mann-Whitney)
Comparison: Null Hypothesis: There is no difference between Arm 2 and Arm 3 in percentage of HIV-1-specific CD4+ T-cells expressing any cytokine (CD40L, CD107a, IFNg, MIP1B, TNFa) in response to Nef protein stimulant.p-value: 0.88Wilcoxon (Mann-Whitney)
Comparison: Null Hypothesis: There is no difference between Arm 1 and Arm 2 in percentage of HIV-1-specific CD4+ T-cells expressing any cytokine (CD40L, CD107a, IFNg, MIP1B, TNFa) in response to Pol protein stimulant.p-value: 0.061Wilcoxon (Mann-Whitney)
Comparison: Null Hypothesis: There is no difference between Arm 1 and Arm 3 in percentage of HIV-1-specific CD4+ T-cells expressing any cytokine (CD40L, CD107a, IFNg, MIP1B, TNFa) in response to Pol protein stimulant.p-value: 0.042Wilcoxon (Mann-Whitney)
Comparison: Null Hypothesis: There is no difference between Arm 2 and Arm 3 in percentage of HIV-1-specific CD4+ T-cells expressing any cytokine (CD40L, CD107a, IFNg, MIP1B, TNFa) in response to Pol protein stimulant.p-value: 0.54Wilcoxon (Mann-Whitney)
Secondary
HIV-1-specific CD8+ and T-cell Responses to Nef, Gag, Pol and Env by Flow Cytometry
Percent of HIV-1-specific CD8+ T-cells expressing any cytokine/marker (CD40L, CD107a, IFNg, MIP1B, TNFa) to each of the 4 protein stimulants (nef, gag, pol and env) by flow cytometry while HIV-1 RNA is suppressed on ART. The results for a specific participant are calculated by subtracting the corresponding background control value (media control). If the result would be less than zero after background subtraction, the result was set to zero. Cytokine/Marker Names: CD40 ligand (CD40L); Cluster of Differentiation 107a (CD107a); Interferon gamma (IFNg); Macrophage Inflammatory Protein beta (MIP1B); Tumor Necrosis Factor alpha (TNFa)
Time frame: At 48 weeks
Population: Participants who maintained HIV-1 RNA\<50 copies/mL at week 48 with no ART interruption of 7 or more consecutive days, no prior virologic failure (defined as having two consecutive HIV-1 RNA \>200 copies/mL at week 24 or later or at any time after achieving HIV-1 RNA \<50 copies/mL ), had available CAHD results from week 48 or week 49, had available immunology marker results where active control result is greater than or equal to the media control, and were enrolled during Fiebig Stage I-V.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Arm 1: Fiebig I/II | HIV-1-specific CD8+ and T-cell Responses to Nef, Gag, Pol and Env by Flow Cytometry | CD8+ T-cell Response to Env | 0.00 Percentage of CD8+ T-cells |
| Arm 1: Fiebig I/II | HIV-1-specific CD8+ and T-cell Responses to Nef, Gag, Pol and Env by Flow Cytometry | CD8+ T-cell Response to Gag | 0.15 Percentage of CD8+ T-cells |
| Arm 1: Fiebig I/II | HIV-1-specific CD8+ and T-cell Responses to Nef, Gag, Pol and Env by Flow Cytometry | CD8+ T-cell Response to Nef | 0.03 Percentage of CD8+ T-cells |
| Arm 1: Fiebig I/II | HIV-1-specific CD8+ and T-cell Responses to Nef, Gag, Pol and Env by Flow Cytometry | CD8+ T-cell Response to Pol | 0.00 Percentage of CD8+ T-cells |
| Arm 2: Fiebig III/IV | HIV-1-specific CD8+ and T-cell Responses to Nef, Gag, Pol and Env by Flow Cytometry | CD8+ T-cell Response to Pol | 0.05 Percentage of CD8+ T-cells |
| Arm 2: Fiebig III/IV | HIV-1-specific CD8+ and T-cell Responses to Nef, Gag, Pol and Env by Flow Cytometry | CD8+ T-cell Response to Env | 0.00 Percentage of CD8+ T-cells |
| Arm 2: Fiebig III/IV | HIV-1-specific CD8+ and T-cell Responses to Nef, Gag, Pol and Env by Flow Cytometry | CD8+ T-cell Response to Nef | 0.15 Percentage of CD8+ T-cells |
| Arm 2: Fiebig III/IV | HIV-1-specific CD8+ and T-cell Responses to Nef, Gag, Pol and Env by Flow Cytometry | CD8+ T-cell Response to Gag | 0.33 Percentage of CD8+ T-cells |
| Arm 3: Fiebig V | HIV-1-specific CD8+ and T-cell Responses to Nef, Gag, Pol and Env by Flow Cytometry | CD8+ T-cell Response to Pol | 0.08 Percentage of CD8+ T-cells |
| Arm 3: Fiebig V | HIV-1-specific CD8+ and T-cell Responses to Nef, Gag, Pol and Env by Flow Cytometry | CD8+ T-cell Response to Gag | 0.28 Percentage of CD8+ T-cells |
| Arm 3: Fiebig V | HIV-1-specific CD8+ and T-cell Responses to Nef, Gag, Pol and Env by Flow Cytometry | CD8+ T-cell Response to Nef | 0.33 Percentage of CD8+ T-cells |
| Arm 3: Fiebig V | HIV-1-specific CD8+ and T-cell Responses to Nef, Gag, Pol and Env by Flow Cytometry | CD8+ T-cell Response to Env | 0.00 Percentage of CD8+ T-cells |
Comparison: Null Hypothesis: There is no difference between Arm 1 and Arm 2 in percentage of HIV-1-specific CD8+ T-cells expressing any cytokine (CD40L, CD107a, IFNg, MIP1B, TNFa) in response to Env protein stimulant.p-value: 0.97Wilcoxon (Mann-Whitney)
Comparison: Null Hypothesis: There is no difference between Arm 1 and Arm 3 in percentage of HIV-1-specific CD8+ T-cells expressing any cytokine (CD40L, CD107a, IFNg, MIP1B, TNFa) in response to Env protein stimulant.p-value: 0.21Wilcoxon (Mann-Whitney)
Comparison: Null Hypothesis: There is no difference between Arm 2 and Arm 3 in percentage of HIV-1-specific CD8+ T-cells expressing any cytokine (CD40L, CD107a, IFNg, MIP1B, TNFa) in response to Env protein stimulant.p-value: 0.12Wilcoxon (Mann-Whitney)
Comparison: Null Hypothesis: There is no difference between Arm 1 and Arm 2 in percentage of HIV-1-specific CD8+ T-cells expressing any cytokine (CD40L, CD107a, IFNg, MIP1B, TNFa) in response to Gag protein stimulant.p-value: 0.055Wilcoxon (Mann-Whitney)
Comparison: Null Hypothesis: There is no difference between Arm 1 and Arm 3 in percentage of HIV-1-specific CD8+ T-cells expressing any cytokine (CD40L, CD107a, IFNg, MIP1B, TNFa) in response to Gag protein stimulant.p-value: 0.28Wilcoxon (Mann-Whitney)
Comparison: Null Hypothesis: There is no difference between Arm 2 and Arm 3 in percentage of HIV-1-specific CD8+ T-cells expressing any cytokine (CD40L, CD107a, IFNg, MIP1B, TNFa) in response to Gag protein stimulant.p-value: 0.38Wilcoxon (Mann-Whitney)
Comparison: Null Hypothesis: There is no difference between Arm 1 and Arm 2 in percentage of HIV-1-specific CD8+ T-cells expressing any cytokine (CD40L, CD107a, IFNg, MIP1B, TNFa) in response to Nef protein stimulant.p-value: 0.35Wilcoxon (Mann-Whitney)
Comparison: Null Hypothesis: There is no difference between Arm 1 and Arm 3 in percentage of HIV-1-specific CD8+ T-cells expressing any cytokine (CD40L, CD107a, IFNg, MIP1B, TNFa) in response to Nef protein stimulant.p-value: 0.007Wilcoxon (Mann-Whitney)
Comparison: Null Hypothesis: There is no difference between Arm 2 and Arm 3 in percentage of HIV-1-specific CD8+ T-cells expressing any cytokine (CD40L, CD107a, IFNg, MIP1B, TNFa) in response to Nef protein stimulant.p-value: 0.045Wilcoxon (Mann-Whitney)
Comparison: Null Hypothesis: There is no difference between Arm 1 and Arm 2 in percentage of HIV-1-specific CD8+ T-cells expressing any cytokine (CD40L, CD107a, IFNg, MIP1B, TNFa) in response to Pol protein stimulant.p-value: 0.085Wilcoxon (Mann-Whitney)
Comparison: Null Hypothesis: There is no difference between Arm 1 and Arm 3 in percentage of HIV-1-specific CD8+ T-cells expressing any cytokine (CD40L, CD107a, IFNg, MIP1B, TNFa) in response to Pol protein stimulant.p-value: 0.044Wilcoxon (Mann-Whitney)
Comparison: Null Hypothesis: There is no difference between Arm 2 and Arm 3 in percentage of HIV-1-specific CD8+ T-cells expressing any cytokine (CD40L, CD107a, IFNg, MIP1B, TNFa) in response to Pol protein stimulant.p-value: 0.6Wilcoxon (Mann-Whitney)
Secondary
Proportion of Participants With Undetectable Cell-associated HIV-1 DNA (CAHD) Prior to ART Initiation
Proportion of participants with 0 copies of CAHD per million CD4+ blood-derived CD4+ T-cells (assayed by quantitative PCR \[qPCR\]), assessed separately and jointly by integrase and gag assays. In order for a participant to be considered as having 0 copies of CAHD for joint assays, the participant must be found to have an undetectable CAHD result from both integrase and gag assays. If all participants in both arms had undetectable CAHD then the statistical test was not performed.
Time frame: At week 0
Population: All participants who enrolled during Fiebig Stage I-V and had available CAHD at week 0.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Arm 1: Fiebig I/II | Proportion of Participants With Undetectable Cell-associated HIV-1 DNA (CAHD) Prior to ART Initiation | Integrase Assay | 0.04 Proportion of participants |
| Arm 1: Fiebig I/II | Proportion of Participants With Undetectable Cell-associated HIV-1 DNA (CAHD) Prior to ART Initiation | Joint Assay (Integrase + Gag) | 0.00 Proportion of participants |
| Arm 1: Fiebig I/II | Proportion of Participants With Undetectable Cell-associated HIV-1 DNA (CAHD) Prior to ART Initiation | Gag Assay | 0.00 Proportion of participants |
| Arm 2: Fiebig III/IV | Proportion of Participants With Undetectable Cell-associated HIV-1 DNA (CAHD) Prior to ART Initiation | Integrase Assay | 0.03 Proportion of participants |
| Arm 2: Fiebig III/IV | Proportion of Participants With Undetectable Cell-associated HIV-1 DNA (CAHD) Prior to ART Initiation | Joint Assay (Integrase + Gag) | 0.01 Proportion of participants |
| Arm 2: Fiebig III/IV | Proportion of Participants With Undetectable Cell-associated HIV-1 DNA (CAHD) Prior to ART Initiation | Gag Assay | 0.01 Proportion of participants |
| Arm 3: Fiebig V | Proportion of Participants With Undetectable Cell-associated HIV-1 DNA (CAHD) Prior to ART Initiation | Joint Assay (Integrase + Gag) | 0.00 Proportion of participants |
| Arm 3: Fiebig V | Proportion of Participants With Undetectable Cell-associated HIV-1 DNA (CAHD) Prior to ART Initiation | Gag Assay | 0.00 Proportion of participants |
| Arm 3: Fiebig V | Proportion of Participants With Undetectable Cell-associated HIV-1 DNA (CAHD) Prior to ART Initiation | Integrase Assay | 0.07 Proportion of participants |
Comparison: Results from Joint Assay. Null Hypothesis: There is no difference between Arm 1 and Arm 2 in the proportion of participants with undetectable CA-DNA.p-value: 1Fisher Exact
Comparison: Results from Joint Assay. Null Hypothesis: There is no difference between Arm 2 and Arm 3 in the proportion of participants with undetectable CA-DNA.p-value: 1Fisher Exact
Comparison: Results from Integrase Assay. Null Hypothesis: There is no difference between Arm 1 and Arm 2 in the proportion of participants with undetectable CA-DNA.p-value: 0.64Fisher Exact
Comparison: Results from Integrase Assay. Null Hypothesis: There is no difference between Arm 1 and Arm 3 in the proportion of participants with undetectable CA-DNA.p-value: 0.69Fisher Exact
Comparison: Results from Integrase Assay. Null Hypothesis: There is no difference between Arm 2 and Arm 3 in the proportion of participants with undetectable CA-DNA.p-value: 0.4Fisher Exact
Comparison: Results from Gag Assay. Null Hypothesis: There is no difference between Arm 1 and Arm 2 in the proportion of participants with undetectable CA-DNA.p-value: 1Fisher Exact
Comparison: Results from Gag Assay. Null Hypothesis: There is no difference between Arm 2 and Arm 3 in the proportion of participants with undetectable CA-DNA.p-value: 1Fisher Exact