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HIV InfectionsPhase 1NCT03239899

PD-1 Inhibition to Determine CNS Reservoir of HIV-Infection

A Phase 1 study testing Pembrolizumab in people with HIV Infections, run by National Institute of Neurological Disorders and Stroke (NINDS) at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Background: HIV affects millions of people. The disease may "hide" in the brain, even in people with well-controlled HIV without cancer. Then it may "wake up" and continue. The drug pembrolizumab uses the body's immune system to fight cells like cancer cells. It is approved to treat some cancers but not HIV. Read more about this study

Who is it for?
Ages 18 to 120 years
Conditions the study is for
HIV Infections
What is being tested?
Pembrolizumab
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
13 participants
Where
1 siteUnited States
Study dates
9 Apr 2018to 13 Feb 2023
Phase
Phase 1
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 120 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • 18 years or older
  • Diagnosis of HIV-1 infection, with positive HIV 1 antibody testing
  • HIV RNA less than or equal to 40 copies/mL in plasma in the last 12 or greater months
  • CD4 count above 350 cells/uL
  • Antiretroviral therapy for 12 months prior to trial
  • Fully vaccinated against SARS-CoV-2. Fully vaccinated is defined as:
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  • Two weeks out from the second dose of a two-dose vaccine series (Moderna, Pfizer-BioNTech); or
  • Two weeks out from a single-dose vaccine (Johnson \& Johnson/Janssen)
  • Patient must be willing and able to comply with all the aspects of trial design and follow-up.
  • Patients must be able to provide informed consent
  • Women of childbearing potential must agree to use contraception (defined as two forms of effective birth control), from the time of enrollment until 4 months after the last exposure to pembrolizumab
  • Participants who are physically able to father a child must agree to use 2 effective methods of contraception (birth control) from the time you enroll in the study until 4 months after your last exposure to pembrolizumab
  • Effective methods of contraception for this study include:
  • hormonal contraception (birth control pills, birth control patches, injected hormones, hormonal implants or vaginal ring),
  • Intrauterine device,
  • Barrier methods (condom or diaphragm) combined with spermicide, and
  • Surgical sterilization (hysterectomy, tubal ligation, or vasectomy).
  • If you have had a hysterectomy, tubal ligation, or vasectomy (or have a partner with a hysterectomy, tubal ligation or vasectomy), you do not have to use 2 methods of birth control.

Who cannot join

  • Clinically significant medical disorders that might expose the patient to undue risk of harm confound study outcomes or prevent the patient from completing the study as identified on screening studies and by patient history. Examples of such conditions include known cardiac disease such as congestive heart failure, chronic obstructive pulmonary disease, uncontrolled hypertension, kidney disease, liver disease, endocrine disease, pulmonary disease, heart disease, progressive CNS disease such as Parkinson s disease, dementia, prior tuberculosis infection or ongoing CNS opportunistic infection.
  • Patient has received immunomodulatory/immunosuppressive therapy (including IV steroids but excluding local injections) in the preceding 6 months.
  • Patient with known autoimmunity that would include but is not limited to disorders such as hypo/hyperthyroidism, myasthenia gravis, diabetes mellitus type 1, hemolytic anemia, and immune mediated hepatitis (but excluding patients with hypothyroidism already on thyroid replacement therapy).
  • Prior history of cancer (excluding non-invasive squamous and basal cell carcinoma)
  • Any opportunistic infection in the prior 2 years (excluding thrush) including latent TB (or a positive TB Quantiferon Gold test)
  • Patient has received other investigational drugs within 3 months before enrollment
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  • Positive serological or PCR evidence of active or prior infection with HTLV-1/II, Hepatitis B or C. Patients with hepatitis B core (+), surface antibody (+), surface antigen ( ) and hepatitis B DNA (-) eligible to participate in the study (provided they are on tenofovir, lamivudine or TAF). Participants with prior hepatitis C who are hepatitis C antibody (+) but hepatitis C RNA (-) with normal liver enzymes and no evidence of cirrhosis on clinical liver ultrasound are eligible to participate in the study.
  • Metal in the body which would make having an MRI scan unsafe, such as pacemakers, stimulators, pumps, aneurysm clips, metallic prostheses, artificial heart valves, cochlear implants or shrapnel fragments, or history of welding or metal worker
  • Claustrophobia
  • Inability to lie comfortably on the back for up to two hours.
  • Abnormal anti-thyroid panel (anti-TPO and anti-TG) test at screening visit.
  • Abnormal screening/baseline blood tests exceeding any of the limits defined below or as deemed exclusionary by the investigators on review:
  • AST and ALT values >1.1 times ULN
  • Fasting triglyceride > 300 mg/dL
  • Total bilirubin >1.1 times ULN (unless participant is taking atazanavir or has Gilbert syndrome)
  • Creatinine Clearance or eGFR <60 ml/minute (adjusted for race)
  • Hemoglobin < 10 g/dL
  • Absolute neutrophil count < 1000/microliter
  • Platelet count <130,000/mm(3) (if platelet clumping is present on hematology slide review, platelet count <100,000/mm3 is considered exclusionary to study)
  • Hemoglobin A1c greater than or equal to 6%
  • Thyroid-stimulating hormone (TSH) and adrenocorticotropic hormone (ACTH) within normal limits. If TSH is not within normal limits then the participant may be eligible if thyroxine (T4) is within normal limits. Participants are not excluded if they are on a stable dose of replacement thyroid medication; dose may be adjusted as needed.
  • An employee or staff of the NIH

Trial locations and contacts

1 site in 1 country.

United States1 site
  • National Institutes of Health Clinical Center

    Bethesda, Maryland, 20892

Other trials in United States

About this study

Background:

HIV affects millions of people. The disease may "hide" in the brain, even in people with well-controlled HIV without cancer. Then it may "wake up" and continue. The drug pembrolizumab uses the body's immune system to fight cells like cancer cells. It is approved to treat some cancers but not HIV. Researchers want to see if it is safe for HIV-positive people without cancer. This study is not for HIV treatment; only one dose of the drug will be used.

Read more

Objective:

To learn if the drug pembrolizumab, used to treat certain cancers, is safe for HIV-positive people.

Eligibility:

Adults ages 18 and older with HIV who are in another NIH protocol

Design:

Participants will be screened with:

  • Medical history
  • Physical and neurological exams
  • Blood tests
  • Lumbar puncture. The lower back will be numbed. A needle will remove fluid from between back bones.
  • FDG-PET/CT. A radioactive sugar will be injected in a thin plastic tube (catheter) inserted in an arm vein. Participants will rest for an hour, urinate, then lie in the scanner. A mask will hold the head still.
  • Leukapheresis. An optional procedure at baseline. White blood cells are removed from you using a serum cell separator machine

Women who can become pregnant cannot take pembrolizumab. Men who take it must use 2 kinds of contraception.

Participants will have up to 7 more visits, which repeat some screening tests.

At 1 visit, participants will get one dose of pembrolizumab by catheter for 30 minutes. They will get allergy and pain medicines.

At 2 visits, participants will have a brain MRI. They will get a contrast agent by catheter. They will lie in a metal cylinder that takes pictures for 1-2 hours. They will get earplugs for loud sounds.

Read the detailed description

Objective

In this Phase I, proof-of-concept study, we aim to determine the safety and tolerability of pembrolizumab, an FDA-approved monoclonal antibody against programmed cell death protein (PD)-1, in viremically suppressed human immunodeficiency virus-1 (HIV) positive patients. We are examining the correlation of immune activation and suppression markers in viremically suppressed HIV positive patients with the effects of pembrolizumab on immune restoration function (e.g. CD4 count, HIV viral load) and immune activation (e.g. HIV-specific T-cell responses).

Study Population

HIV is estimated to infect 37.6 million people globally, with 690,000 deaths and 1.5 million new infections occurring yearly. There is no cure. Opportunistic infections and neoplasms contribute to a large portion of mortality and morbidity within the HIV-positive population. Even in well- controlled, viremically suppressed patients, neurologic complications including HIV-associated neurocognitive disorder, continue to contribute to disease morbidity and mortality.

There is evidence that HIV reservoirs contribute to the inability to cure HIV infection. In the brain, macrophages and astrocytes harbor HIV. It is theorized that the brain is a potential reservoir for replication competent HIV. PD-1 expression is elevated in patients with HIV compared to uninfected controls. Upregulated PD-1 expression is associated with higher viral load and increased mortality in infections.1 PD-1 co-expression on regulatory T-cells has been shown to correlate with disease progression in perinatally-infected HIV-positive children. Drugs targeting the PD-1 pathway in HIV infection have shown upregulation of T-cell responses that are potentially critical to eradication of infection. Pembrolizumab is an attractive option due to its mechanism of action, although it has been rarely used in the HIV population.

Design

In this single-center, single-arm, open label, baseline-versus-treatment phase I clinical trial, twelve patients with HIV-1 infection receive a one-time dose of 200mg pembrolizumab with a baseline study period of 3 weeks, a one-day treatment phase, and a 6-month post treatment phase. Outcome measures are collected every 3 to 6 weeks for the duration of the study.

Outcome Measures

The primary outcome is the safety and tolerability of pembrolizumab, which is measured by clinical exam, laboratory studies and adverse event tabulations using the Common Terminology Criteria for Adverse Events (CTCAE) v5.0.

In addition, viral and immunologic outcome measures investigating the impact of pembrolizumab on HIV-1 biology and its effects on immune function is measured in the CSF and periphery, including single copy HIV analysis, CD4+ T-cell count, PD-1 lymphocyte expression and T-cell phenotype analysis, T-cell proliferation against HIV-proteins, CSF cytokine analysis and/or CSF antibody profiling (LIPS). These additional studies offer indirect proof of a HIV viral reservoir in the CNS as well as potential efficacy of pembrolizumab in reversing immune exhaustion against latent HIV

Conditions
HIV Infections
Being tested
Pembrolizumab
Keywords
HIV, Brain, Immunotherapy
Medical subject headings
HIV Infections

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • PembrolizumabDrug

    Participants will receive one dose of 2mg/kg of pembrolizumab IV at Week 0.

Study groups in NCT03239899
Study groupRoleWhat they receive
HIV ParticipantsExperimentalParticipants who received 200 mg of Pembrolizumab administered as a one-time intravenous infusion over 30 minutes during the treatment phase of the study.
Receives: Drug: Pembrolizumab

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Frequency of Grade 3 or Higher Adverse Events

    The frequency of Grade 3 and higher Adverse Events (AEs) that are probably or definately causal to pembrolizumab was calculated for the duration of the study, i.e., up to 52 weeks following infusion of pembrolizumab.

    Measured: study duration (up to 52 weeks post infusion)

Secondary outcomes (6)
  1. Change in HIV-specific Antibody Responses in the CSF and Serum Using LIPS Assay.

    Analysis of the effects of pembrolizumab on various immunologic responses (antigens) was conducted at baseline and 3 weeks after infusion of pembrolizumab.

    Antibody responses have been correlated with cure responses in the "Berlin patient". Utilizing the "Berlin patient's" antibody levels as a benchmark for the post-treatment of the study participants, a change in the following antigens was analyzed at 3 weeks post-infusion of pembrolizumab, in CSF and serum: p24, Matrix, gp120, Reverse transcriptase, Integrate, Protease, and pg41. A positive value suggests exposure to the HIV protein; while a negative value suggests no exposure to the HIV protein.

    Measured: 3 weeks after infusion

  2. Change in CSF Cytokine Profile Post-study Drug

    A change in CSF cytokine profile was measured between baseline and 3 weeks after infusion of pembrolizumab. Cytokines are proteins that communicate with and trigger the immune system to attack invaders in the body. An increase in an individual cytokine level after 3 weeks suggests an immune reaction.

    Measured: 3 weeks after infusion

  3. Peripheral CD4 Counts

    A change in peripheral CD4 counts was measured from baseline to 3 weeks post-infusion of pembrolizumab. CD4 T cells help coordinate the immune response by stimulating other immune cells, such as macrophages, B lymphocytes (B cells), and CD8 T lymphocytes (CD8 cells), to fight infection. HIV weakens the immune system by destroying CD4 cells. CD4 counts in the blood were measured at baseline and 3 weeks after infusion of pembrolizumab. A positive value suggests an increase in the CD4 count while a negative value suggests a decrease in the CD4 count.

    Measured: 3 weeks after infusion

  4. HIV RNA in Plasma and CSF

    Change in HIV RNA levels was measured in plasma and CSF from baseline to 3 weeks after pembrolizumab infusion. A positive change value suggests an increase in viral load, while a negative change value suggests a decrease in viral load.

    Measured: 3 weeks after infusion

  5. Change in FDG-PET/CT Metabolic Uptake in CNS

    Change in FDG-PET/CT metabolic uptake in the CNS from baseline to 3 weeks after infusion of pembrolizumab was measured. A change reflecting an increase in update might suggest higher metabolic activity in that brain region, while a change reflecting a decrease in uptake might suggest lower metabolic activity in that brain region.

    Measured: 3 weeks after infusion

  6. Change in PD-1 Expression in the CSF and Blood Cells

    A change in PD-1 expression on CD4 and CD8 T cells in the CSF and blood cells, was measured from baseline to 3 weeks after infusion of Pembrolizumab. A decline in PD-1 expression on CD4 and CD8 T cells suggests more potential T cell targeting response.

    Measured: 3 weeks after infusion

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted4 Aug 2017
  2. Study start9 Apr 2018
  3. Primary completion13 Feb 2023
  4. Study completion13 Feb 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 1
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
13 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03239899
Sponsor's protocol ID
170145
Other IDs
17-N-0145
Status last verified
13 Feb 2023
First submitted
3 Aug 2017
Last updated
2 Oct 2025
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
Yes: All IPD that underlie results in a publication

Publications

  • Henderson LJ, Reoma LB, Kovacs JA, Nath A. Advances toward Curing HIV-1 Infection in Tissue Reservoirs. J Virol. 2020 Jan 17;94(3):e00375-19. doi: 10.1128/JVI.00375-19. Print 2020 Jan 17.

    PubMed 31694954

Questions about this trial

What is this clinical trial studying?

A Phase 1 study testing Pembrolizumab in people with HIV Infections, run by National Institute of Neurological Disorders and Stroke (NINDS) at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 18 inclusion and 22 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 2 Oct 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 13 Feb 2024). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Frequency of Grade 3 or Higher Adverse Events (time frame: study duration (up to 52 weeks post infusion)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03239899, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 Oct 2025.

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