HIV Infections
Conditions
Keywords
HIV, H1N1 vaccination, HIV infected individuals
Brief summary
The overall goal of this study is to study influenza vaccine responses in HIV infected individuals. Immunocompromised individuals require special protection from influenza, but may not respond appropriately to the standard killed vaccine. Patients who receive the H1N1 flu vaccine as part of their standard of care will be asked to donate blood samples for immunologic studies. These studies will determine whether participants were able to produce the appropriate antibodies to the vaccine and possibly identify predictors of vaccine responsiveness. Our hypothesis is that vaccine responsiveness to the new H1N1 influenza vaccine will be compromised in HIV infected patients.
Interventions
BIOLOGICALH1N1 vaccination
Novartis unadjuvanted inactivated S-OIV H1N1 influenza vaccine 15 mcg administered as single-0.5mL (15mcg) injection intramuscularly into one of the subject's deltoid muscles
Sponsors
University of Pennsylvania
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. A confirmed diagnosis of HIV-1 infection as documented by any licensed ELISA test kit and confirmed by Western blot at any time prior to study entry or any measurable HIV RNA viral load in the chart. Serum HIV-1 antigen, plasma HIV-1 RNA, or a second antibody test by a method other than ELISA is acceptable as an alternative confirmatory test. 2. \> 18 years 3. Able to understand and comply with planned study procedures. 4. Provides written informed consent prior to initiation of any study procedures. 5. Subject should be 1) on stable antiretroviral therapy as outlined in the DHHS treatment guidelines for HIV-1 infected individuals OR 2) not on antiretroviral therapy and not intending to start treatment within the next 30 days.
Exclusion criteria
1. Has a known allergy to eggs or other components in the vaccines (these may include, but are not limited to: gelatin, formaldehyde, octoxinol and chicken protein). 2. Has a history, in the opinion of the site investigator, of severe reactions following previous immunization with seasonal TIV. 3. Participation in a novel H1N1 influenza vaccine study in the past two years. 4. Proven history, by RT-PCR, of novel influenza H1N1 infection, or, has a positive influenza diagnostic testing since June 2009 (specificity to H1N1 not required) prior to study entry. 5. Received any other live licensed vaccine within 4 weeks or inactivated licensed vaccine within 1 week prior to study entry. 6. Scheduled administration of any live virus vaccine or inactivated vaccine at or between entry and the Day 21 visit. NOTE: Live or inactivated vaccines expected to be administered between study entry and the Day 21 visit should be excluded to prevent potential interference with immunogenicity responses and confounding safety results. Regular seasonal flu vaccination will be allowed if is separated more than 7 days from the administration of the H1N1 vaccine. 7. Received a non-licensed agent (vaccine, drug, biologic, device, blood product, or medication) within 4 weeks prior to vaccination in this study 8. An acute illness and/or an oral temperature greater than or equal to 100.0 degrees F within 24 hours prior to study entry. 9. Use of anti-cancer chemotherapy or radiation therapy within the preceding 36 months of study enrollment, or has immunosuppression as a result of an underlying illness or treatment (other than HIV-1 infection). 10. Active neoplastic disease (excluding non-melanoma skin cancer, and HPV-related cervical dysplasia, CIN grades 1, 2 or 3). 11. Long term use of glucocorticoids, including oral or parenteral prednisone or equivalent (more than 2.0 mg/kg per day or more than 20 mg total dose) for more than 2 consecutive weeks (or 2 weeks total) in the past 3 months, or high-dose inhaled steroids (\>800 mcg/day of beclomethasone dipropionate or equivalent) within the past 3 months (nasal and topical steroids are allowed). 12. Received immunoglobulin or other blood products 13. Current diagnosis of uncontrolled major psychiatric disorder. 14. History of Guillain-Barré Syndrome in the subject or subject's family (parents, siblings, half siblings, or children). 15. Any condition that would, in the opinion of the site investigator, place the subject at an unacceptable risk of injury or render the subject unable to meet the requirements of the protocol.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Safety | 21-28 days | To assess the safety of inactivated swine-origin H1N1 influenza vaccine in HIV-1 infected individuals (received as part of standard of care). Safety was assessed via 1. Adverse Events of Grade 3 or higher of abnormal laboratory values, signs and symptoms or diagnoses. 2. Solicited local AEs, including pain, tenderness, redness, and swelling post each vaccination. Solicited systemic AEs, including feverishness, malaise, body aches (exclusive of the injection site), nausea, and headache post each vaccination. |
| Immunogenicity | 21-28 days | Immunologic response, defined as HAI titer ≥ 1:40, at 21 days after vaccine dose. |
Countries
United States
Participant flow
Recruitment details
The study was conducted at the MacGregor Clinic of the Hospital of the University of Pennsylvania in Philadelphia, Pennsylvania, USA, between the months of November and January 2009-2010. All patients signed an informed consent. The study was approved by the University of Pennsylvania institutional review board .
Participants by arm
| Arm | Count |
|---|---|
| Vaccination Group (Single Arm Study) All participants | 120 |
| Total | 120 |
Baseline characteristics
| Characteristic | Vaccination Group (Single Arm Study) |
|---|---|
| Age, Continuous | 46 years |
| Ethnicity (NIH/OMB) Hispanic or Latino | 7 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 113 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Percentage of Participants at Baseline with HAI assay titers ≥ 1:40 | 25 percentage of participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 2 Participants |
| Race (NIH/OMB) Black or African American | 81 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) White | 37 Participants |
| Sex: Female, Male Female | 35 Participants |
| Sex: Female, Male Male | 85 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 31 / 120 |
| serious Total, serious adverse events | 0 / 120 |
Outcome results
Primary
Immunogenicity
Immunologic response, defined as HAI titer ≥ 1:40, at 21 days after vaccine dose.
Time frame: 21-28 days
Population: Among the 90 participants without evidence of previous exposure to H1N1, only 61% \[95% confidence interval (CI) 51-71\] developed protective titers by week 3 of the study (seroconversion rate).
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Vacinees | Immunogenicity | 61 percentage of seroconversion |
Primary
Safety
To assess the safety of inactivated swine-origin H1N1 influenza vaccine in HIV-1 infected individuals (received as part of standard of care). Safety was assessed via 1. Adverse Events of Grade 3 or higher of abnormal laboratory values, signs and symptoms or diagnoses. 2. Solicited local AEs, including pain, tenderness, redness, and swelling post each vaccination. Solicited systemic AEs, including feverishness, malaise, body aches (exclusive of the injection site), nausea, and headache post each vaccination.
Time frame: 21-28 days
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Vacinees | Safety | Malaise | 19 percentage of participants |
| Vacinees | Safety | Pain | 22 percentage of participants |
| Vacinees | Safety | Induration | 0 percentage of participants |
| Vacinees | Safety | Tenderness | 18 percentage of participants |
| Vacinees | Safety | Ecymosis | 0 percentage of participants |
| Vacinees | Safety | Headache | 16 percentage of participants |
| Vacinees | Safety | Myalgia | 18 percentage of participants |
| Vacinees | Safety | Nausea | 4 percentage of participants |
| Vacinees | Safety | Chills | 3 percentage of participants |
| Vacinees | Safety | Vomiting | 1 percentage of participants |
| Vacinees | Safety | Redness | 3 percentage of participants |
| Vacinees | Safety | Fever | 1 percentage of participants |