Prophylactic treatment with broadly neutralizing antibody VRC01 selects for escape mutants after infection in Antibody-Mediated Prevention trials.

VRC01 prophylaxis in HIV prevention selects for escape mutants in 8 of 26 treated participants, with mutations conferring resistance emerging after infection.

• Why it matters: Understanding how broadly neutralizing antibodies influence viral evolution is crucial for improving HIV prevention strategies, as escape mutations can undermine long-term efficacy.
• What they did: The study analyzed 11,730 HIV envelope sequences from 47 participants in AMP trials, identifying VRC01-mediated escape mutations in treated individuals but not in placebo recipients.
• The result: Findings suggest that prophylactic VRC01 can promote viral escape post-infection, highlighting the need for next-generation bnAbs with greater breadth and potency to improve prevention durability.