HIV Infections
Conditions
Keywords
HIV Infections, Ib, Immunological Non-Responders
Brief summary
The Phase Ib clinical trial is an add-on study based on combination antiretroviral therapy (cART). It adopts a multicenter, randomized, double-blind, placebo-controlled, multiple-dose design to evaluate the safety and efficacy of multiple intramuscular injections of JL18008 added to cART in HIV immunological non-responders (INRs). Based on the Phase Ia clinical data, three dose groups are planned for the Phase Ib trial: 20, 40, and 70 μg/kg of JL18008. Each group is planned to enroll 10 subjects (8 receiving active drug and 2 receiving placebo). All subjects must maintain their original cART regimen unchanged. Subjects in the active treatment groups will receive JL18008 injection in addition to cART, while those in the control group will receive placebo (JL18008 injection buffer) in addition to cART. The dosing regimen is tentatively once weekly (QW) for 4 consecutive weeks, which constitutes one treatment cycle, followed by an observation/follow-up period. The study drug will be administered by intramuscular injection.
Interventions
DRUGJL18008 20 μg/kg
Participants receive JL18008 20 μg/kg by intramuscular injection once weekly for 4 weeks, in addition to their stable combination antiretroviral therapy (cART).
Participants receive placebo (JL18008 injection buffer) by intramuscular injection once weekly for 4 weeks, in addition to their stable combination antiretroviral therapy (cART).
DRUGJL18008 40 μg/kg
Participants receive JL18008 40 μg/kg by intramuscular injection once weekly for 4 weeks, in addition to their stable combination antiretroviral therapy (cART).
Participants receive placebo (JL18008 injection buffer) by intramuscular injection once weekly for 4 weeks, in addition to their stable combination antiretroviral therapy (cART).
DRUGJL18008 70 μg/kg
Participants receive JL18008 70 μg/kg by intramuscular injection once weekly for 4 weeks, in addition to their stable combination antiretroviral therapy (cART).
Participants receive placebo (JL18008 injection buffer) by intramuscular injection once weekly for 4 weeks, in addition to their stable combination antiretroviral therapy (cART).
Sponsors
Jecho Biopharmaceuticals Co., Ltd.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
1. Age 18 to 65 years (inclusive), male or female. 2. Body mass index (BMI) 18.0 to 32.0 kg/m² (inclusive); body weight ≥50.0 kg for males and ≥45.0 kg for females. 3. Receiving combination antiretroviral therapy (cART) for at least 48 months, with a stable antiretroviral regimen for at least 3 months prior to enrollment. Maintained HIV-1 RNA below 50 copies/mL for at least 36 months (the earliest test date more than 36 months before enrollment), including transient viral blips (single HIV-1 RNA measurement between 50 and 200 copies/mL after excluding laboratory error). At least two HIV-1 RNA results \<50 copies/mL must be available (one may be from screening). 4. Immunological non-responder criteria: CD4⁺ T cell count ≤350 cells/μL within 1 year before screening. At least three CD4⁺ T cell counts ≤350 cells/μL within 4 years before enrollment, with intervals of ≥3 months between tests (the third may be from screening). 5. Willing to use effective non-pharmacological contraception with partner from screening until 3 months after study completion, and no plan for sperm/egg donation during this period. 6. Able to understand and provide written informed consent, and willing to comply with all protocol-specified visits and procedures.
Exclusion criteria
1. Known allergy to the study drug or any of its excipients. 2. Receipt of immunosuppressants, immunomodulators, or systemic cytotoxic therapy within 3 months before screening. 3. Receipt of hormone therapy within 1 month before screening, except for daily doses ≤10 mg prednisone or equivalent. 4. History of severe autoimmune disease requiring systemic treatment or hospitalization, or any active autoimmune disease requiring treatment (including multiple sclerosis). 5. History of systemic infection (viral, bacterial, parasitic, or fungal) requiring systemic treatment and/or hospitalization, or other opportunistic infection, within 30 days before screening. 6. Active tuberculosis lesion within 30 days before screening. 7. Blood disorders associated with hypersplenism (e.g., thalassemia, hereditary spherocytosis, Gaucher's disease, autoimmune hemolytic anemia) or history of splenectomy. 8. Chronic diarrhea. 9. Severe cardiovascular disease within 6 months before screening, including myocardial infarction, unstable angina, congestive heart failure (NYHA class ≥II), or arrhythmia requiring medication. 10. Uncontrolled hypertension, defined as resting systolic blood pressure \>140 mmHg and/or diastolic blood pressure \>90 mmHg on at least two repeated measurements on different days despite antihypertensive treatment. 11. Positive hepatitis B surface antigen (HBsAg), or positive hepatitis C virus antibody (HCV-Ab) with detectable HCV-RNA, or active syphilis. 12. Any of the following laboratory abnormalities at screening: hemoglobin \<90 g/L; neutrophil count \<1.5×10⁹/L; platelet count \<100×10⁹/L; serum creatinine \>1.5× upper limit of normal (ULN); alanine aminotransferase \>2.5×ULN; aspartate aminotransferase \>2.5×ULN; alkaline phosphatase \>2.5×ULN; total bilirubin \>1.5×ULN; international normalized ratio \>1.5; activated partial thromboplastin time \>1.5×ULN. 13. Diagnosis of cancer within the screening period. 14. Severe neurological or psychiatric disease, or history of seizures. 15. History of drug abuse within 3 months before screening, or positive urine drug screen (including morphine, methamphetamine, ketamine, MDMA, THC, cocaine), or history of alcohol abuse. 16. Participation in another clinical trial with receipt of investigational drug within 3 months before screening. 17. Vaccination within 6 weeks before screening, or plan to receive any vaccination within 1 year after enrollment. 18. Pregnancy, positive pregnancy test, or breastfeeding. 19. Any other condition that, in the opinion of the investigator, makes the subject unsuitable for participation in this clinical study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants with Treatment-Emergent Adverse Events (TEAEs) as Assessed by DAIDS v2.1 | Up to 24 weeks | The incidence and severity of adverse events (AEs) and serious adverse events (SAEs). Adverse events are graded according to the Division of AIDS (DAIDS) Table for Grading the Severity of Adult and Pediatric Adverse Events, Version 2.1. Assessed from first dose up to Week 24. |
| Change from Baseline in Vital Signs: Pulse Rate (bpm) | Up to 24 weeks | Change from baseline in pulse rate. Measured in beats per minute (bpm). Assessed at baseline and Weeks 1, 4, 8, 12, 16, 20, and 24. |
| Change from Baseline in Vital Signs: Systolic and Diastolic Blood Pressure (mmHg) | Up to 24 weeks | Change from baseline in systolic blood pressure (SBP) and diastolic blood pressure (DBP). Both measured in millimeters of mercury (mmHg). Assessed at baseline and Weeks 1, 4, 8, 12, 16, 20, and 24. |
| Change from Baseline in Hematology Parameters | Up to 24 weeks | Change from baseline in hematology parameters including white blood cell count (10\^9/L), hemoglobin (g/L), platelet count (10\^9/L), neutrophil count (10\^9/L), lymphocyte count (10\^9/L), and red blood cell count (10\^12/L). Assessed at baseline and Weeks 1, 2, 4, 8, 12, 16, 20, and 24. |
| Change from Baseline in Serum Chemistry Parameters | Up to 24 weeks | hange from baseline in serum chemistry parameters including alanine aminotransferase (ALT, U/L), aspartate aminotransferase (AST, U/L), creatinine (μmol/L), triglycerides (mmol/L), total cholesterol (mmol/L), glucose (mmol/L), and electrolytes (Na⁺, K⁺, Cl-, Ca²⁺, Mg²⁺, Pi). Assessed at baseline and Weeks 1, 2, 4, 8, 12, 16, 20, and 24. |
| Change from Baseline in Coagulation Parameters | Up to 24 weeks | Change from baseline in coagulation parameters including international normalized ratio (INR), activated partial thromboplastin time (APTT, seconds), prothrombin time (PT, seconds), and fibrinogen (g/L). Assessed at baseline and Weeks 1, 2, 4, 8, 12, 16, 20, and 24. |
| Change from Baseline in ECG Parameter: QTcF Interval | Up to 24 weeks | Change from baseline in the QT interval corrected for heart rate using Fridericia's formula (QTcF). Measured in milliseconds (ms). Assessed at baseline and Weeks 1, 4, 8, 12, 16, 20, and 24. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of Participants with CD4⁺ T Cell Count Increase ≥100 cells/μL from Baseline | Up to 24 weeks | Proportion of participants achieving an increase from baseline in CD4⁺ T cell count of at least 100 cells/μL. Assessed at baseline and Weeks 4, 8, 12, 16, 20, and 24. |
| Proportion of Participants Achieving CD4⁺ T Cell Count ≥500 cells/μL | Up to 24 weeks | Proportion of participants with CD4⁺ T cell count reaching 500 cells/μL or higher. Assessed at Weeks 4, 8, 12, 16, 20, and 24. |
| Proportion of Participants with Average CD4⁺ T Cell Count Increase ≥100 cells/μL over 12 Weeks | Baseline through Week 12 | Proportion of participants with average increase from baseline in CD4⁺ T cell count of at least 100 cells/μL over the first 12 weeks. Assessed from baseline through Week 12. |
| Proportion of Participants with Average CD4⁺ T Cell Count ≥500 cells/μL over 12 Weeks | Baseline through Week 12 | Proportion of participants with average CD4⁺ T cell count of 500 cells/μL or higher over the first 12 weeks. Assessed from baseline through Week 12. |
| Proportion of Participants with Average CD4⁺ T Cell Count Increase ≥100 cells/μL over 24 Weeks | Baseline through Week 24 | Proportion of participants with average increase from baseline in CD4⁺ T cell count of at least 100 cells/μL over the 24-week study period. Assessed from baseline through Week 24. |
| Proportion of Participants with Average CD4⁺ T Cell Count ≥500 cells/μL over 24 Weeks | Baseline through Week 24 | Proportion of participants with average CD4⁺ T cell count of 500 cells/μL or higher over the 24-week study period. Assessed from baseline through Week 24. |
| Change from Baseline in CD4/CD8 T Cell Ratio | Up to 24 weeks | Change from baseline in the ratio of CD4⁺ to CD8⁺ T cells. Assessed at baseline and Weeks 4, 8, 12, 16, 20, and 24. |
| Proportion of Participants with HIV-1 RNA <50 copies/mL | Up to 24 weeks | Proportion of participants maintaining HIV-1 RNA below 50 copies/mL. Assessed at Weeks 4, 8, 12, 16, 20, and 24. |
| Number of Participants with Clinical Events | Up to 24 weeks | Number of participants experiencing clinical events including opportunistic infections, malignancies, and non-AIDS complications (e.g., cardiovascular, renal, hepatic events). Assessed from first dose up to Week 24. |
| Change from Baseline in Serum Cytokine Levels (IL-2, IL-4, IL-6, IL-8, IL-10, TNF-α, IFN-γ) | Up to 24 weeks | Change from baseline in serum levels of cytokines. All measured in pg/mL. Assessed at baseline, Days 1, 2, 3, 5, 8, 15, 22, 23, 24, 26, 29, and Weeks 8, 12, 16, 20, 24. |
| Change from Baseline in Lymphocyte Subset Counts (cells/μL) | Up to 24 weeks | Change from baseline in absolute counts of lymphocytes, T cells (CD3⁺), CD8⁺ T cells, B cells (CD19⁺), natural killer cells (CD56⁺), and their subsets including memory, naive, regulatory, and activation markers (CD38⁺, HLA-DR⁺, PD-1⁺). Assessed at baseline, Days 1, 2, 3, 5, 8, 15, 22, 23, 24, 26, 29, and Weeks 8, 12, 16, 20, 24. |
| Peak Plasma Concentration (Cmax) - Single Dose | Up to 168 hours after first dose | Maximum observed plasma concentration following the first dose. Derived directly from the concentration-time data. Measured in pg/mL. Assessed at pre-dose and at 1, 2, 4, 8, 12, 24, 48, 96, and 168 hours post-dose. |
| Time to Reach Peak Plasma Concentration (Tmax) - Single Dose | Up to 168 hours after first dose | Time to reach maximum observed plasma concentration following the first dose. Measured in hours (h). Assessed at pre-dose and at 1, 2, 4, 8, 12, 24, 48, 96, and 168 hours post-dose. |
| Elimination Half-Life (t½) - Single Dose | Up to 168 hours after first dose | Elimination half-life following the first dose. Calculated as ln(2)/λz, where λz is the terminal elimination rate constant. Measured in hours (h). Assessed at pre-dose and at 1, 2, 4, 8, 12, 24, 48, 96, and 168 hours post-dose. |
| Area Under the Curve from Time 0 to Last Measurable Concentration (AUC0-last) - Single Dose | Up to 168 hours after first dose | Area under the plasma concentration-time curve from time 0 to the time of the last measurable concentration following the first dose. Calculated using the linear trapezoidal rule. Measured in h·pg/mL. Assessed at pre-dose and at 1, 2, 4, 8, 12, 24, 48, 96, and 168 hours post-dose. |
| Area Under the Curve from Time 0 to Infinity (AUC0-inf) - Single Dose | Up to 168 hours after first dose | Area under the plasma concentration-time curve from time 0 extrapolated to infinity following the first dose. Calculated as AUC0-last + Clast/λz. Measured in h·pg/mL. Assessed at pre-dose and at 1, 2, 4, 8, 12, 24, 48, 96, and 168 hours post-dose. |
| Area Under the Curve from Time 0 to 168 Hours (AUC0-168h) - Single Dose | Up to 168 hours after first dose | Area under the plasma concentration-time curve from time 0 to 168 hours following the first dose. Measured in h·pg/mL. Assessed at pre-dose and at 1, 2, 4, 8, 12, 24, 48, 96, and 168 hours post-dose. |
| Apparent Clearance (CL/F) - Single Dose | Up to 168 hours after first dose | Apparent total clearance of the drug from plasma following extravascular administration. Calculated as Dose / AUC0-inf. Measured in L/h. Assessed at pre-dose and at 1, 2, 4, 8, 12, 24, 48, 96, and 168 hours post-dose. |
| Apparent Volume of Distribution (Vz/F) - Single Dose | Up to 168 hours after first dose | Apparent volume of distribution during the terminal phase following extravascular administration. Calculated as Dose / (λz \* AUC0-inf). Measured in L. Assessed at pre-dose and at 1, 2, 4, 8, 12, 24, 48, 96, and 168 hours post-dose. |
| Steady-State Peak Plasma Concentration (Cmax, ss) | Up to 168 hours after the fourth dose (Week 4) | Maximum observed plasma concentration at steady state following the fourth dose (Week 4). Measured in pg/mL. Assessed at pre-dose and at 1, 2, 4, 8, 12, 24, 48, 96, and 168 hours after the fourth dose. |
| Steady-State Time to Reach Peak Plasma Concentration (Tmax, ss) | Up to 168 hours after the fourth dose (Week 4) | Time to reach maximum observed plasma concentration at steady state following the fourth dose. Measured in hours (h). Assessed at pre-dose and at 1, 2, 4, 8, 12, 24, 48, 96, and 168 hours after the fourth dose. |
| Steady-State Minimum Plasma Concentration (Cmin, ss) | Up to 168 hours after the fourth dose (Week 4) | Minimum observed plasma concentration at steady state following the fourth dose. Measured in pg/mL. Assessed at pre-dose and at 1, 2, 4, 8, 12, 24, 48, 96, and 168 hours after the fourth dose. |
| Steady-State Average Plasma Concentration (Cavg, ss) | Up to 168 hours after the fourth dose (Week 4) | Average plasma concentration at steady state over the dosing interval. Calculated as AUC0-tau / τ. Measured in pg/mL. Assessed at pre-dose and at 1, 2, 4, 8, 12, 24, 48, 96, and 168 hours after the fourth dose. |
| Area Under the Curve Over Dosing Interval (AUC0-tau) - Steady State | Up to 168 hours after the fourth dose (Week 4) | Area under the plasma concentration-time curve over the dosing interval (168 hours) at steady state. Measured in h·pg/mL. Assessed at pre-dose and at 1, 2, 4, 8, 12, 24, 48, 96, and 168 hours after the fourth dose. |
| Steady-State Area Under the Curve from Time 0 to Infinity (AUC0-inf, ss) | Up to 168 hours after the fourth dose (Week 4) | Area under the plasma concentration-time curve from time 0 extrapolated to infinity at steady state. Measured in h·pg/mL. Assessed at pre-dose and at 1, 2, 4, 8, 12, 24, 48, 96, and 168 hours after the fourth dose. |
| Steady-State Apparent Clearance (CLss/F) | Up to 168 hours after the fourth dose (Week 4) | Apparent total clearance at steady state. Calculated as Dose / AUC0-tau. Measured in L/h. Assessed at pre-dose and at 1, 2, 4, 8, 12, 24, 48, 96, and 168 hours after the fourth dose. |
| Steady-State Apparent Volume of Distribution (Vss/F) | Up to 168 hours after the fourth dose (Week 4) | Apparent volume of distribution at steady state. Measured in L. Assessed at pre-dose and at 1, 2, 4, 8, 12, 24, 48, 96, and 168 hours after the fourth dose. |
| Steady-State Elimination Half-Life (t½, ss) | Up to 168 hours after the fourth dose (Week 4) | Elimination half-life at steady state. Measured in hours (h). Assessed at pre-dose and at 1, 2, 4, 8, 12, 24, 48, 96, and 168 hours after the fourth dose. |
| Degree of Fluctuation (DF) - Steady State | Up to 168 hours after the fourth dose (Week 4) | Degree of fluctuation at steady state. Calculated as (Cmax, ss - Cmin, ss) / Cavg, ss. No units. Assessed at pre-dose and at 1, 2, 4, 8, 12, 24, 48, 96, and 168 hours after the fourth dose. |
| Accumulation Ratio for Cmax (RacCmax) | From first dose to steady state (Week 4) | Accumulation ratio for peak concentration. Calculated as Cmax, ss / Cmax following first dose. No units. Assessed after first dose and after fourth dose (Week 4). |
| Accumulation Ratio for AUC (RacAUC0-tau) | From first dose to steady state (Week 4) | Accumulation ratio for area under the curve. Calculated as AUC0-tau, ss / AUC0-tau following first dose. No units. Assessed after first dose and after fourth dose (Week 4). |
| Number of Participants with Anti-Drug Antibodies (ADA) | Up to 24 weeks | Number and percentage of participants who develop anti-drug antibodies (ADA) against JL18008. For ADA-positive participants, titers and neutralizing antibody (Nab) status will be assessed. Assessed at baseline, Days 8, 15, 22, 29, and Weeks 8, 12, 16, 20, 24. |
Countries
China
Contacts
CONTACTProf. Taisheng Li
Outcome results
None listed