Study of Lenacapavir, Teropavimab, and Zinlirvimab Versus Cabotegravir and Rilpivirine in Virologically Suppressed Adults With HIV-1 on Oral Daily Antiretroviral Therapy

Prior treatment

• Active, serious infections (other than HIV-1) requiring therapy \< 30 days prior to randomization.
• Acute hepatitis of any cause \< 30 days before randomization.
• Have poor venous access that would limit phlebotomy or intravenous (IV) infusion of study drugs.
• Prior use of, or exposure to, LEN or a broadly neutralizing antibody (bNAb) for HIV-1.
• Prior use of, or exposure to, long-acting (LA) injectable CAB or LA injectable RPV.
• Prior use of, or exposure to, ibalizumab, fostemsavir, or maraviroc.
• Treatment with immunosuppressant therapies (eg, corticosteroids, immunoglobulins, and other immune- or cytokine-based therapies) within 4 weeks of screening (with the exception of a single short course of corticosteroids lasting ≤ 7 days) or have a comorbid condition with an anticipated need ongoing immunosuppressive treatment during the study.

Other illness

• History of an opportunistic infection or illness indicative of Stage 3 HIV disease.
• History of treatment failure.
• Individuals with a dermatologic condition or implanted prothesis overlying the gluteal injection site for CAB + RPV.
• Known hypersensitivity to the study intervention, its metabolites, or formulation excipients.
• Active tuberculosis infection.
• History of, or current clinical decompensated liver cirrhosis (eg, ascites, encephalopathy, or variceal bleeding) or severe hepatic impairment (Child-Pugh Class C).
• Active malignancy requiring acute systemic therapy.
• Hepatitis C virus (HCV) antibody positive and HCV RNA detectable.
• Chronic hepatitis B virus (HBV) infection, as determined by either:
  • Positive HBV surface antigen and negative HBV surface antibody, regardless of HBV core antibody status, at the screening visit.
  • Positive HBV core antibody and negative HBV surface antibody, regardless of HBV surface antigen status, at the screening visit.
• Severe renal impairment-estimated glomerular filtration rate \< 30 mL/min according to the Cockcroft-Gault formula.

Lab values

• Any of the following laboratory values at screening:
  • Alanine aminotransferase \> 5 x upper limit of normal (ULN).
  • Direct bilirubin \> 1.5 x ULN.
  • Platelets \< 50,000/mm\^3.
  • Hemoglobin \< 8.0 g/dL.
  • Note: Other protocol defined Inclusion/Exclusion criteria may apply.

Other

• Known or suspected resistance to either CAB or RPV.
  • Resistance to CAB defined as the following mutations: G118R, Q148K, Q148R, T66K+L74M, E92Q+N155H, E138A+Q148R, E138K+Q148K/R, G140C+Q148R, G140S+Q148H/K/R, Y143H+N155H, and Q148R+N155H.
  • Resistance to RPV defined as the following mutations: K101E and P; E138A, G, K, R, and Q; V179L; Y181C, I, and V; Y188L; H221Y; F227C; M230I and L, and the combination of L100I/K103N.
• Baseline regimen consisting of monotherapy with any single antiretroviral (ARV).
• Abnormal electrocardiogram (ECG) at the screening visit that is clinically significant, as determined by the investigator.

• Human immunodeficiency virus type 1 (HIV-1) susceptibility results from screening meeting specific criteria:
  • 1\) Proviral phenotypic susceptibility to both TAB and ZAB by the investigational protocol-defined assay at screening.
• At least 1 documented HIV-1 RNA level measured between 6 months and 12 months (+2 months) prior to screening. This and any other HIV-1 RNA measurements documented in this period must be \< 50 copies/mL (undetectable HIV-1 RNA level according to the local assay being used if the limit of detection is ≥ 50 copies/mL). A single virologic elevation of ≥ 50 copies/mL and \< 400 copies/mL (transient detectable viremia or "blips") prior to screening are acceptable if the subsequent plasma HIV-1 RNA level is \< 50 copies/mL.
• A plasma HIV-1 RNA test \< 50 copies/mL (undetectable HIV-1 RNA level according to the local assay being used if the limit of detection is ≥ 50 copies/mL) within the last 6 months prior to screening.
  • 1\) If \> 1 plasma HIV-1 RNA measurements in the last 6 months prior to screening are available, all must be \< 50 copies/mL (undetectable HIV-1 RNA level according to the local assay being used if the limit of detection is ≥ 50 copies/mL).
• On a stable oral ARV therapy (ART) for ≥ 6 months prior to screening.
  • A change in ART regimen ≥ 3 months prior to the screening visit for reasons other than virologic failure (VF) (eg, tolerability, simplification, drug-drug interaction profile) is allowed; individuals with a change in ART regimen ≥ 3 months prior to screening must have been on the regimen for ≥ 3 months prior to screening, and all HIV-1 RNA measurements in that period must be \< 50 copies/mL. There are no permitted changes to ART regimens between screening and Day 1.