CCR5-edited CD4(+) T cells augment HIV-specific immunity to enable post-rebound control of HIV replication

BACKGROUND. We conducted a phase I clinical trial that infused CCR5 gene-edited CD4(+) T cells to determine how these T cells can better enable HIV cure strategies. METHODS. The aim of trial was to develop RNA-based approaches to deliver zinc finger nuclease (ZFN), evaluate the effect of CCR5 gene-edited CD4(+) T cells on the HIV-specific T cell response, test the ability of infused CCR5 gene-edited T cells to delay viral rebound during analytical treatment interruption, and determine whether individuals heterozygous for CCR5.32 preferentially benefit. We enrolled 14 individuals living with HIV whose viral load was well controlled by antiretroviral therapy (ART). We measured the time to viral rebound after ART withdrawal, the persistence of CCR5-edited CD4(+) T cells, and whether infusion of 10 billion CCR5-edited CD4(+) T cells augmented the HIV-specific immune response. RESULTS. Infusion of the CD4(+) T cells was well tolerated, with no serious adverse events. We observed a modest delay in the time to viral rebound relative to historical controls; however, 3 of the 14 individuals, 2 of whom were heterozygous for CCR5.32, showed post-viral rebound control of viremia, before ultimately losing control of viral replication. Interestingly, only these individuals had substantial restoration of HIV-specific CD8(+) T cell responses. We observed immune escape for 1 of these reinvigorated responses at viral recrudescence, illustrating a direct link between viral control and enhanced CD8(+) T cell responses. CONCLUSION. These findings demonstrate how CCR5 gene-edited CD4(+) T cell infusion could aid HIV cure strategies by augmenting preexisting HIV-specific immune responses. REGISTRATION. ClinicalTrials.gov NCT02388594.