A Phase 1/2 interventional study of Nucleoside Reverse Transcriptase Inhibitors (NRTIs) and Nevirapine (NVP) in HIV Infection, sponsored by National Institute of Allergy and Infectious Diseases (NIAID). Recruiting at 47 sites in 13 countries. Open to participants aged Up to 48 Hours. Per ClinicalTrials.gov, last updated 2026-09-09.
Sponsored by National Institute of Allergy and Infectious Diseases (NIAID) · Phase 1/2, Interventional, and Treatment
The study will explore the effects of early intensive antiretroviral therapy (ART) with or without a broadly neutralizing antibody (bNAb) on achieving HIV remission (HIV RNA below the limit of detection of the assay) among infants living with HIV.
The purpose of this study is to explore the effects of early intensive antiretroviral therapy (ART) on achieving HIV remission (HIV RNA below the limit of detection of the assay) among infants living with HIV.
The study will enroll two cohorts. Cohort 1 will include infants born to a mother with presumed or confirmed HIV infection who received no or very limited antiretrovirals during pregnancy. Cohort 2 will include infants with at least one positive HIV nucleic acid test result from a sample collected within 48 hours of birth who initiated a qualifying ART regimen within 48 hours of birth.
Seven early intensive therapy regimens will be assessed. Regimen 1L will include 2 nucleoside reverse transcriptase inhibitors (NRTIs) plus nevirapine (NVP) plus lopinavir/ritonavir (LPV/r). Regimen 2R will include 2 NRTIs plus NVP plus raltegravir (RAL). Regimen 2RV will include 2 NRTIs plus NVP plus RAL plus VRC01 monoclonal antibody. Regimen 3RD will include 2 NRTIs plus NVP plus RAL with subsequent switch to 2 NRTIs plus dolutegravir (DTG) upon reaching 28 days of age and 3 kg body weight. Regimen 3RDV7 will include 2 NRTIs plus NVP plus RAL plus VRC07-523LS with subsequent switch to 2 NRTIs plus DTG plus VRC07-523LS upon reaching 28 days of age and 3 kg body weight. Regimen 4D will include 2 NRTIs plus DTG. Regimen 4DV7 will include 2 NRTIs plus DTG plus VRC07-523LS.
The study will be conducted in four steps. In Step 1, Cohort 1 infants will be enrolled for evaluation of HIV infection and initiation of early intensive therapy within 48 hours of birth. Infants in whom in utero HIV infection is excluded will switch from the study regimen to standard perinatal prophylaxis per local guidelines within two weeks; these infants will continue in Step 1 safety monitoring for two additional weeks, undergo HIV testing at approximately 24 weeks of age, and then exit the study. Infants in whom in utero HIV infection is confirmed will enter Step 2 at least two weeks after enrollment in Step 1.
In Step 2, infants will receive the study regimen for up to 192 weeks. Beginning at Step 2 Week 84, children who achieved HIV RNA suppression by Week 24, and maintained suppression, thereafter, will be evaluated for possible analytic treatment interruption (ATI).
In Step 3, children in Step 2 who meet criteria for ATI will interrupt ART and be closely monitored for viral rebound for up to ten years.
In Step 4, children who experience viral rebound in Step 3 or meet other Step 4 inclusion criteria will re-initiate ART and be closely monitored for viral re-suppression on ART until five years of age or six months after re-suppression, whichever is later.
Maternal Inclusion Criteria
Presumed or confirmed maternal HIV infection:
Mothers will be eligible to enroll with EITHER:
Infant Inclusion Criteria for Step 1
Infant Inclusion Criteria for Step 2
Infant Inclusion Criteria for Step 3
Has the following results based on testing:
No plasma HIV RNA detected at Step 2 Week 48 and thereafter, with two possible exceptions
Has met ALL of the following additional criteria while in Step 2, based on testing between Step 2 Week 84 and Step 2 Week 192 (inclusive):
Infant Inclusion Criteria for Step 4
Has met at least one of the following:
Participants will receive 2 NRTIs + NVP + LPV/r.
Drug: Nucleoside Reverse Transcriptase Inhibitors (NRTIs) · Drug: Nevirapine (NVP) · Drug: Lopinavir/Ritonavir (LPV/r)
Participants will receive 2 NRTIs + NVP + LPV/r.
Drug: Nucleoside Reverse Transcriptase Inhibitors (NRTIs) · Drug: Nevirapine (NVP) · Drug: Lopinavir/Ritonavir (LPV/r)
Participants will receive 2 NRTIs + NVP + RAL.
Drug: Nucleoside Reverse Transcriptase Inhibitors (NRTIs) · Drug: Nevirapine (NVP) · Drug: Raltegravir (RAL)
Participants will receive 2 NRTIs + NVP + RAL.
Drug: Nucleoside Reverse Transcriptase Inhibitors (NRTIs) · Drug: Nevirapine (NVP) · Drug: Raltegravir (RAL)
Participants will receive 2 NRTIs + NVP + RAL + VRC01.
Drug: Nucleoside Reverse Transcriptase Inhibitors (NRTIs) · Drug: Nevirapine (NVP) · Drug: Raltegravir (RAL) · Drug: VRC01
Participants will receive 2 NRTIs + NVP + RAL with subsequent switch to 2 NRTIs + DTG upon reaching 28 days of age and 3 kg body weight.
Drug: Nucleoside Reverse Transcriptase Inhibitors (NRTIs) · Drug: Nevirapine (NVP) · Drug: Raltegravir (RAL) · Drug: Dolutegravir (DTG)
Participants will receive 2 NRTIs + NVP + RAL + VRC07-523LS with subsequent switch to 2 NRTIs + DTG + VRC07-523LS upon reaching 28 days of age and 3 kg body weight.
Drug: Nucleoside Reverse Transcriptase Inhibitors (NRTIs) · Drug: Nevirapine (NVP) · Drug: Raltegravir (RAL) · Drug: Dolutegravir (DTG) · Drug: VRC07-523LS
Participants will receive 2 NRTIs + DTG
Drug: Nucleoside Reverse Transcriptase Inhibitors (NRTIs) · Drug: Dolutegravir (DTG)
Participants will receive 2 NRTIs + DTG + VRC07-523LS
Drug: Nucleoside Reverse Transcriptase Inhibitors (NRTIs) · Drug: Dolutegravir (DTG) · Drug: VRC07-523LS
Chosen by the site investigator and dosed according to World Health Organization (WHO) or individual country or local standard guidelines.
Administered orally. Dosed according to study step/participant's age/participant's weight.
Administered orally. Dosed according to study step and participant's age.
Administered orally. Dosed according to study step and participant's age.
40 mg/kg administered subcutaneously.
Dosed according to study step/participant's age/participant's weight
40 mg/kg administered subcutaneously.
Number of participants who achieve HIV remission
Defined as no confirmed HIV RNA greater than or equal to the limit of detection (LOD) through 48 weeks of treatment interruption
Time frame: Measured through Week 48
Frequency of Grade 3 or higher adverse events possibly, probably or definitely related to any component of the study regimen
Graded according to the DAIDS AE Grading Table, Corrected Version 2.1, dated July 2017
Time frame: Measured through Week 192
Number of participants with viral suppression to consistent HIV-1 RNA less than LOD
Based on laboratory evaluations
Time frame: Measured through Week 24
Number of participants meeting all eligibility criteria for treatment interruption
As defined in criteria described in study protocol
Time frame: Measured through Week 192
Number of infants meeting the selected eligibility criteria for treatment interruption among infants who also met the viral suppression criteria for treatment interruption.
As defined in criteria described in the study protocol
Time frame: Measured through Week 192
Number of participants who experience HIV persistence
As measured by plasma viremia (single copy), droplet digital DNA, replication competent HIV reservoirs
Time frame: Measured through Week 48
Change in HIV-specific immune response
As measured by %CD8+/DR+ T cells
Time frame: Measured through Week 48
Change in immune activation markers (%CD8+/DR+ T cells) response
As measured by HIV-specific antibodies and HIV-specific T cell responses
Time frame: Measured through Week 48
Change in DTG concentration among treated neonates and young infants
Based on laboratory evaluations
Time frame: Measured through Week 24
Change in VRC07-523LS concentration among treated neonates and young infants
Based on laboratory evaluations
Time frame: Measured through Week 24
Presence of ARV genotypic resistance to drugs taken
Time frame: Measured through Week 48
Presence of bNAb resistance as measured by inhibitory concentration
Time frame: Measured through Week 48
Plan to share: Yes — Individual participant data that underlie results in the publication, after deidentification.
Supporting information: Study protocol, Sap
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National Institute of Allergy and Infectious Diseases (NIAID)