These monoclonal antibodies can be genetically altered so they can either
- work against more than one envelope protein (adding extra moiety on to the antibody) thus making them more potent – see Tri-specific bNAb below or
- remain in circulation longer to facilitate longer action making easier dosing
Professor Daniel Kuritzkes summarised the potential and current trials of broadly neutralizing antibodies for HIV-1. There were some familiar concepts from the development of ART. Monotherapy rapidly leads to resistant mutations. Large trials will be needed to prove non-inferiority to existing treatments. They will not have a role as therapy until cost can be driven down and more convenient formulations are developed.
There were some potential advantages:
- Therapeutic regimens that involved a 3 or 6 monthly subcutaneous injection to treat HIV are not fanciful and may help overcome adherence and stigma problems
- They have no impact on the current use of antiretrovirals
There were some significant cautions:
- The prospect of treatments that alter immune function facilitating cancer or other immune diseases is real
The uses of NnAbs in HIV were summarise below. There is currently a trial investigating their use as PrEP
