{
  "abstract": "Broadly neutralizing antibodies (bnAbs) show promise in HIV prevention, yet viral escape remains a challenge. In the Antibody-Mediated Prevention (AMP) trials, the CD4 binding site (CD4bs) bnAb VRC01 blocked acquisition by VRC01-sensitive strains. However, its influence on viral evolution post acquisition is not fully understood. Here we analysed 11,730 HIV envelope sequences generated during the AMP trials from 47 participants, identifying VRC01-mediated de novo escape mutations in 8 of 26 VRC01-treated participants but none in 21 placebo participants. These mutations were found at very low frequencies (<1%) in globally circulating viruses, suggesting that they may confer fitness costs. Escape mutations, primarily located in the Loop-D and β23/V5 regions of Env, conferred cross-resistance to several CD4bs bnAbs; however, more potent CD4bs bnAbs such as N6 and 1–18 largely retained their activity. Our findings demonstrate that prophylactic VRC01 can select for viral escape after infection, underscoring the need for next-generation bnAbs with improved breadth and potency to enhance durability and efficacy of antibody-based HIV prevention.",
  "abstract_shown": true,
  "affiliations": [
    "Division of Medical Virology, Institute of Infectious Disease and Molecular Medicine and Wellcome CIDRI-Africa Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa",
    "National Health Laboratory Service, Johannesburg, South Africa",
    "Centre for the AIDS Programme of Research in South Africa, University of Kwa-Zulu Natal, Durban, South Africa",
    "SA MRC Antibody Immunity Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa",
    "National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa",
    "Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA USA",
    "US Military HIV Research Program, CIDR, Walter Reed Army Institute of Research, Silver Spring, MD USA",
    "Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD USA",
    "Department of Global Health, University of Washington, Seattle, WA USA",
    "Department of Microbiology, University of Washington, Seattle, WA USA",
    "Present Address: Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA USA",
    "Los Alamos National Laboratory, Los Alamos, NM USA",
    "Santa Fe Institute, Santa Fe, NM USA",
    "Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Solna, Sweden",
    "University of Zimbabwe College of Health Sciences Clinical Trials Research Centre, Harare, Zimbabwe",
    "Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA USA",
    "Department of Surgery, Duke University Medical Center, Durham, NC USA",
    "Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA",
    "Wits Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 49,
  "authors": [
    {
      "affs": [
        0,
        1,
        2
      ],
      "name": "Carolyn Williamson",
      "orcid": "0000-0003-0125-1226"
    },
    {
      "affs": [
        0
      ],
      "name": "Lyle Curry"
    },
    {
      "affs": [
        3,
        4
      ],
      "name": "Nonhlanhla N. Mkhize",
      "orcid": "0000-0003-3037-1243"
    },
    {
      "affs": [
        5
      ],
      "name": "Elena E. Giorgi"
    },
    {
      "affs": [
        5
      ],
      "name": "Craig A. Magaret",
      "orcid": "0000-0002-5056-2664"
    },
    {
      "affs": [
        3,
        4
      ],
      "name": "Bronwen E. Lambson"
    },
    {
      "affs": [
        3,
        4
      ],
      "name": "Sinethemba Bhebhe"
    },
    {
      "affs": [
        3,
        4
      ],
      "name": "Haajira Kaldine",
      "orcid": "0000-0002-7946-5606"
    },
    {
      "affs": [
        3,
        4
      ],
      "name": "Thandeka Moyo-Gwete"
    },
    {
      "affs": [
        6,
        7
      ],
      "name": "Morgane Rolland",
      "orcid": "0000-0003-3650-8490"
    },
    {
      "affs": [
        5
      ],
      "name": "Raabya Rossenkhan"
    },
    {
      "affs": [
        5
      ],
      "name": "Nina Marie G. Garcia"
    },
    {
      "affs": [
        0
      ],
      "name": "Chivonne Moodley"
    },
    {
      "affs": [
        0
      ],
      "name": "Anna Yssel"
    },
    {
      "affs": [
        5
      ],
      "name": "Yunda Huang",
      "orcid": "0000-0003-1546-6172"
    },
    {
      "affs": [
        3,
        4
      ],
      "name": "Alaine A. Marsden",
      "orcid": "0000-0001-9361-6610"
    },
    {
      "affs": [
        5,
        8
      ],
      "name": "Daniel B. Reeves",
      "orcid": "0000-0001-5684-9538"
    },
    {
      "affs": [
        5
      ],
      "name": "Bryan T. Mayer",
      "orcid": "0000-0003-2258-5276"
    },
    {
      "affs": [
        9
      ],
      "name": "Roger E. Bumgarner",
      "orcid": "0000-0002-8168-6985"
    },
    {
      "affs": [
        0
      ],
      "name": "Nicolas Beaume"
    },
    {
      "affs": [
        9,
        10
      ],
      "name": "Dylan H. Westfall",
      "orcid": "0000-0002-2434-8525"
    },
    {
      "affs": [
        5
      ],
      "name": "Michal Juraska",
      "orcid": "0000-0002-0920-2915"
    },
    {
      "affs": [
        5
      ],
      "name": "Allan C. DeCamp",
      "orcid": "0000-0003-1404-4322"
    },
    {
      "affs": [
        0
      ],
      "name": "Hugh Murrell",
      "orcid": "0000-0002-6185-9885"
    },
    {
      "affs": [
        6,
        7
      ],
      "name": "Hongjun Bai"
    },
    {
      "affs": [
        9,
        10
      ],
      "name": "Wenjie Deng"
    },
    {
      "affs": [
        9
      ],
      "name": "Alec P. Pankow",
      "orcid": "0000-0001-9108-1683"
    },
    {
      "affs": [
        11,
        12
      ],
      "name": "Tanmoy Bhattacharya",
      "orcid": "0000-0002-1060-652X"
    },
    {
      "affs": [
        0
      ],
      "name": "Talita York",
      "orcid": "0000-0003-2884-3010"
    },
    {
      "affs": [
        0
      ],
      "name": "Nonkululeko Ndabambi"
    },
    {
      "affs": [
        9
      ],
      "name": "Lennie Chen"
    },
    {
      "affs": [
        9
      ],
      "name": "Hong Zhao"
    },
    {
      "affs": [
        0
      ],
      "name": "Asanda Gwashu-Nyangiri"
    },
    {
      "affs": [
        0
      ],
      "name": "Ruwayhida Thebus"
    },
    {
      "affs": [
        0
      ],
      "name": "Paula Cohen"
    },
    {
      "affs": [
        13
      ],
      "name": "Ben Murrell",
      "orcid": "0000-0002-0393-4445"
    },
    {
      "affs": [
        5
      ],
      "name": "Shelly Karuna",
      "orcid": "0000-0001-5946-9733"
    },
    {
      "affs": [
        5
      ],
      "name": "John Hural"
    },
    {
      "affs": [
        14
      ],
      "name": "Nyaradzo Mgodi"
    },
    {
      "affs": [
        15
      ],
      "name": "Srilatha Edupuganti"
    },
    {
      "affs": [
        3
      ],
      "name": "Lynn Morris"
    },
    {
      "affs": [
        16
      ],
      "name": "David Montefiori",
      "orcid": "0000-0003-0856-6319"
    },
    {
      "affs": [
        5
      ],
      "name": "M. Juliana McElrath",
      "orcid": "0000-0003-2276-7117"
    },
    {
      "affs": [
        17
      ],
      "name": "Myron S. Cohen"
    },
    {
      "affs": [
        5
      ],
      "name": "Lawrence Corey",
      "orcid": "0000-0002-2179-2436"
    },
    {
      "affs": [
        5
      ],
      "name": "Paul T. Edlefsen",
      "orcid": "0000-0002-8393-8103"
    },
    {
      "affs": [
        5
      ],
      "name": "Peter B. Gilbert",
      "orcid": "0000-0002-2662-9427"
    },
    {
      "affs": [
        2,
        3,
        4,
        18
      ],
      "name": "Penny L. Moore",
      "orcid": "0000-0001-8719-4028"
    },
    {
      "affs": [
        9
      ],
      "name": "James I. Mullins",
      "orcid": "0000-0002-4461-8158"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/7twwgyfvev60a.bib",
  "cited_by": 0,
  "doi": "10.1038/s41564-026-02467-4",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13716832/",
  "id": "7twwgyfvev60a",
  "issns": [
    "2058-5276"
  ],
  "landing_url": "https://doi.org/10.1038/s41564-026-02467-4",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Article"
    ],
    [
      "openalex",
      "2406|HIV Research and Treatment"
    ]
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  "openalex": "W7214605456",
  "pdf_url": "https://www.nature.com/articles/s41564-026-02467-4.pdf",
  "pmcid": "PMC13716832",
  "pmid": "42806020",
  "published": "2026-09-28",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/7twwgyfvev60a.ris",
  "sources": [
    {
      "first_seen": "2026-11-01T12:24:01Z",
      "native_id": "PMC13716832",
      "source": "pmc",
      "url": "https://doi.org/10.1038/s41564-026-02467-4"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "openalex:2406|HIV Research and Treatment",
      "subfield": "microbiology"
    }
  ],
  "title": "Prophylactic treatment with broadly neutralizing antibody VRC01 selects for escape mutants after infection in Antibody-Mediated Prevention trials",
  "title_text": "Prophylactic treatment with broadly neutralizing antibody VRC01 selects for escape mutants after infection in Antibody-Mediated Prevention trials",
  "type": "peer-reviewed",
  "updated_at": "2026-11-02T12:21:16Z",
  "url": "https://research.draconitic.com/paper/7twwgyfvev60a",
  "venue": "Nature Microbiology",
  "versions": []
}