Abstract
BACKGROUND We evaluated the safety and viral rebound, after analytical treatment interruption (ATI), of vedolizumab and ART in recent HIV-1 infection. We used this model to analyze the effect of α4β7 on the HIV-1 reservoir size.METHODS Participants started ART with monthly vedolizumab infusions, and ATI was performed at week 24. Biopsies were obtained from ileum and cecum at baseline and week 24. Vedolizumab levels, HIV-1 reservoir, flow cytometry, and cell-sorting and antibody competition experiments were assayed.RESULTS Vedolizumab was safe and well tolerated. No participant achieved undetectable viremia off ART 24 weeks after ATI. Only a modest effect on the time to achieve more than 1,000 HIV-1 RNA copies/mL and the proportion of participants off ART was observed, being higher in the vedolizumab group compared with historical controls. Just before ATI, α4β7 expression was associated with HIV-1 DNA and RNA in peripheral blood and with PD1 and TIGIT levels. Importantly, a complete blocking of α4β7 was observed on peripheral CD4+ T cells but not in gut (ileum and cecum), where α4β7 blockade and vedolizumab levels were inversely associated with HIV-1 DNA.CONCLUSION Our findings support α4β7 as an important determinant in HIV-1 reservoir size, suggesting the complete α4β7 blockade in tissue as a promising tool for HIV-cure combination strategies.TRIAL REGISTRATION ClinicalTrials.gov NCT03577782.FUNDING This work was supported by the Instituto de Salud Carlos III (Fondo Europeo de Desarrollo Regional, “a way to make Europe,” research contracts FI17/00186 and FI19/00083 and research projects PI18/01532, PI19/01127, PI22/01796), Conserjería de Economía, Conocimiento, Empresas y Universidad, Junta de Andalucía (research projects P20/00906), the Red Temática de Investigación Cooperativa en SIDA (RD16/0025/0020), and the Spanish National Research Council.
Authors
Maria Reyes Jimenez-Leon, Carmen Gasca-Capote, Cristina Roca-Oporto, Nuria Espinosa, Salvador Sobrino, Maria Fontillon-Alberdi, Ce Gao, Isabelle Roseto, Gregory Gladkov, Inmaculada Rivas-Jeremias, Karin Neukam, Jose German Sanchez-Hernandez, Raul Rigo-Bonnin, Antonio J. Cervera-Barajas, Rosario Mesones, Federico García, Ana Isabel Alvarez-Rios, Sara Bachiller, Joana Vitalle, Alberto Perez-Gomez, María Inés Camacho-Sojo, Isabel Gallego, Christian Brander, Ian McGowan, Beatriz Mothe, Pompeyo Viciana, Xu Yu, Mathias Lichterfeld, Luis F. Lopez-Cortes, Ezequiel Ruiz-Mateos
Figure 2
Plasma viral load, proportion of participants off ART, and time to viral load rebound after ATI.
