Ibalizumab: The First Monoclonal Antibody for the Treatment of HIV-1 Infection

Objective:To review the efficacy and safety of ibalizumab (IBA) in the treatment of HIV-1 infection.Data Sources:A literature search was performed using PubMed and Google Scholar (2010 to mid-June 2020) with the search termsTMB-355, TNX-355, andibalizumab. Other resources included abstracts presented at recent conferences and the manufacturer's website and prescribing information.Study Selection and Data Extraction:All relevant English-language articles of studies assessing the efficacy and safety of IBA were included.Data Synthesis:IBA is a monoclonal antibody that blocks HIV-1 from infecting CD4+ T cells. IBA is approved by the Food and Drug Administration, in combination with other antiretrovirals (ARVs), for the treatment of HIV-1 infection in heavily treatment-experienced adults with multidrug-resistant (MDR) HIV-1 infection failing their current ARVs. IBA demonstrated significant and sustained antiviral activity in patients with MDR HIV-1 infection who had advanced disease and limited treatment options. It carries a warning regarding the development of immune reconstitution inflammatory syndrome. Common adverse reactions include diarrhea, dizziness, nausea, and rash.Relevance to Patient Care and Clinical Practice:IBA represents an attractive option for treatment-experienced adults with advanced HIV-1 infection who are no longer able to achieve viral suppression on oral ARV therapy alone and who are able to adhere to an infusion therapy every 2 weeks. As with other biologics, there is a potential for the development of antibodies to IBA that can compromise its efficacy and safety.Conclusion:IBA provides a needed treatment option to achieve and maintain viral suppression in heavily treatment-experienced adults with MDR HIV-1 infection.