Background: As a first step towards HIV cure, we assessed a strategy of antiretroviral therapy (ART) intensification followed by interleukin-7 (IL-7) used as an HIV-reactivating agent.
Methods: A multicentre, randomized clinical trial included patients on suppressive ART with CD4+ cell counts at least 350/μl and HIV-DNA between 10 and 1000 copies/106 peripheral blood mononuclear cells (PBMCs). After an 8-week raltegravir and maraviroc intensification, patients were randomized to intensification alone or with 3 weekly IL-7 injections at weeks 8, 9 and 10. The primary endpoint was at least 0.5 log10 decrease in HIV-DNA in PBMC at W56. Secondary endpoints included ultrasensitive plasma viremia, immunologic changes and safety.
Results: Twenty-nine patients were enrolled with median baseline 558 CD4+ cell counts/μl, 360 HIV-DNA copies/106 PBMCs and 12 years on ART. No patient in either arm achieved the primary endpoint. Addition of IL-7 induced a significant expansion of CD4+ T cells, primarily central-memory cells (+5%, P = 0.001) at week 12, together with an increase in levels of HIV-DNA/106 PBMC (+0.28 log10 copies/P = 0.001), and the proportion of patients with detectable ultrasensitive plasma HIV-RNA increased compared with week 8 (P = 0.07). At weeks 56 and 80, total and memory CD4+ cell counts and total HIV-DNA/ml of blood remained elevated. In contrast, HIV-DNA/million PBMC and plasma viremia returned to baseline levels whereas activated HLA-DR+CD4+ T cells significantly decreased.
Conclusion: IL-7 administration and dual ART intensification induced, despite a mild HIV reactivation, an amplification of the HIV reservoir, as a result of central-memory CD4+ T-cell expansion, thus limiting this IL-7 based strategy.
Clinical trial registration: This trial was registered with ClinicalTrials.gov, number NCT01019551.
aAP-HP, Hôpital Pitié-Salpêtrière, Service de Maladies Infectieuses et Tropicales, Paris
bSorbonne Universités, UPMC Univ Paris 06
cINSERM, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris
dAP-HP, Hôpital Pitié-Salpêtrière, Service de Virologie, Paris
eORVACS, Hôpital Pitié-Salpêtrière, Paris
fINSERM, UMR_S 1135, CIMI, Paris, France
gSan Raffaele Scientific Institute, Milan, Italy
hIrsi Caixa, Foundation. UAB, UVIC-UCC Hospital ‘Germans Trias i Pujol’, Badalona, Catalonia, Spain
iRoyal Free and University College London Medical School, London, UK
jCenter for Global Health and Department of Medicine, Northwestern University, Chicago, Illinois, USA
kAP-HP, Hôpital Pitié-Salpêtrière, Service d’immunologie, Paris, France.
Correspondence to Christine Katlama, MD, AP-HP, Hôpital Pitié-Salpêtrière, Service de Maladies Infectieuses et Tropicales, 43/83, boulevard de l’hôpital, 75013, Paris, France. Tel: +33 1 42 16 01 42; fax: +33 1 42 16 01 66; e-mail: email@example.com
Received 2 March, 2015
Revised 24 May, 2015
Accepted 3 June, 2015
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