HIV
Conditions
Keywords
safety, immunogenicity, HIV vaccine
Brief summary
CUTHIVAC002 is a randomised Phase I study aimed at exploring the safety and immunogenicity of two different modes of delivery of a deoxyribonucleic acid (DNA) vaccine (DNA-C CN54ENV) via combined intramuscular and intradermal methods with and without electroporation, and boosted with recombinant HIV CN54gp140 administered by intradermal injection in healthy volunteers. The aim of this study is to identify optimal DNA delivery conditions for promoting enhanced antibody responses to boosting with recombinant protein by the intradermal method.
Detailed description
CUTHIVAC002 is a randomised Phase I study in healthy volunteers, aimed at exploring the safety and immunogenicity of two different modes of delivery of a deoxyribonucleic acid (DNA) HIV vaccine via combined intramuscular and intradermal methods with and without electroporation (EP), and boosted with recombinant HIV protein vaccine administered by intradermal injection without EP. The aim of this study is to identify optimal DNA delivery conditions for promoting enhanced antibody responses to boosting with recombinant protein by the intradermal route. Healthy male and female volunteers aged 18 to 50 years old, who are at low risk of HIV infection, are to be recruited. The participants will be divided into 3 groups: Group 1: Participants will receive 1 x 0.15 ml (0.6 mg) DNA intradermal injections into the upper arm with EP and 1 x 0.5 ml (2 mg) intramuscular injection into the upper thigh without EP at Weeks 0, 4 & 8. And also 1 x 0.1 ml (50 μg) HIV recombinant protein by intradermal injection into the upper arm at Week 20 (final vaccination). Group 2: Participants will receive 1 x 0.15 ml (0.6 mg) DNA intradermal injections into the upper arm without EP and 1 x 0.5 ml (2 mg) intramuscular injection into the upper thigh with EP at weeks 0, 4 & 8. And also 1 x 0.1 ml (50 μg) HIV recombinant protein by intradermal injection into the upper arm at Week 20 (final vaccination). Group 3: Participants will receive 1 x 0.15 ml (0.6 mg) of DNA of intradermal injections into the upper arm with EP and 1 x 0.5 ml (2 mg) intramuscular injection into the upper thigh with EP at weeks 0, 4 & 8. And also 1 x 0.1 ml (50 μg) HIV recombinant protein by intradermal injection into the upper arm at Week 20 (final vaccination). The investigators aim to have 8 participants complete the study in each group.
Interventions
BIOLOGICALDNA-C CN54ENV
DNA plasmid containing the Clade C gp140 envelope gene from HIV-1 isolate CN54
BIOLOGICALCN54gp140
Recombinant protein expressed from the Clade C gp140 envelope gene from HIV-1 isolate CN54
DEVICETrigrid Delivery System - Intramuscular
Electroporation
DEVICETrigrid Delivery System - Intradermal
Electroporation
Sponsors
Medical Research Council
Imperial College London
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 50 Years
Healthy volunteers
Yes
Inclusion criteria
1. Men and women aged between 18 and 50 years on the day of screening 2. BMI between 18-30 3. Available for follow-up for the duration of the study (\ 5 months from screening) 4. Willing and able to give written informed consent 5. At low risk of HIV and willing to remain so for the duration of the study defined as: * no history of injecting drug use in the previous ten years * no gonorrhoea or syphilis in the last six months * no high risk partner (e.g. injecting drug use, HIV positive partner) either currently or within the past six months * no unprotected anal intercourse in the last six months, outside a relationship with a regular partner known to be HIV negative * no unprotected vaginal intercourse in the last six months outside a relationship with a regular known/presumed HIV negative partner 6. Willing to undergo a HIV test 7. Willing to undergo a genital infection screen 8. Must agree to require male sexual partner to use condoms, from at least 14 days before the first vaccination until at least 14 days after the last 9. If heterosexually active female capable of becoming pregnant, must (in addition to requiring male partner to use condoms) agree to use hormonal contraception, or to complete abstinence, from at least 14 days before the first vaccination until at least 14 days after the last. \[Note: Periodic abstinence (e.g. calendar, ovulation, symptothermal, post-ovulation methods) and withdrawal, and IUD/IUS, are not acceptable methods of contraception.\] If sexually active male, must agree to use condoms from the day of first vaccination until at least 14 days after the last. \[Note: Additional use of an effective method of contraception is recommended for any non-pregnant female partner over the same period.\] 10. Agree to abstain from donating blood for three months after the end of their participation in the trial, or longer if necessary 11. Registered with a GP for at least the past three months 12. Entered and clearance obtained from The Over-volunteering Prevention System (TOPS) database.
Exclusion criteria
1. Pregnant or lactating 2. History of cardiac arrhythmia or palpitations \[e.g., supraventricular tachycardia, atrial fibrillation, frequent ectopy, or sinus bradycardia prior to study entry (sinus arrhythmia is not excluded) 3. History of syncope or fainting episodes within 1 year of study entry 4. History of grand-mal epilepsy, seizure disorder or any history of prior seizure 5. Individuals in which a skin-fold measurement (cutaneous and subcutaneous tissue) of the upper right or left thigh exceeds 40 mm 6. Clinically relevant abnormality on history or examination 7. Known hypersensitivity to any component of the vaccine formulations used in this trial, or have severe or multiple allergies to drugs or pharmaceutical agents 8. History of severe local or general reaction to vaccination defined as * local: extensive, indurated redness and swelling involving most of the antero-lateral thigh or the major circumference of the arm, not resolving within 72 hours * general: fever ≥39.5 °C within 48 hours; anaphylaxis; bronchospasm; laryngeal oedema; collapse; convulsions or encephalopathy within 72 hours 9. Receipt of live attenuated vaccine or HIV envelope components within 60 days or other vaccines within 14 days of enrolment 10. Receipt of an experimental vaccine containing HIV envelope components at any time in the past 11. Receipt of blood products or immunoglobulin within 4 months of screening 12. Participation in another trial of a medicinal product, completed less than 30 days prior to enrolment. 13. HIV 1 or 2 positive or indeterminate on screening. 14. Positive for hepatitis B surface antigen, hepatitis C antibody or serology indicating active syphilis requiring treatment 15. Grade 1 or above routine laboratory parameters. Hyperbilirubinaemia to be considered an exclusion criterion only when confirmed to be conjugated bilirubinaemia 16. Current use of any electronic stimulation device, such as cardiac demand pacemakers, automatic implantable cardiac defibrillator, nerve stimulators, or deep brain stimulators. 17. Presence of any surgical or traumatic metal implants at the sites of administration 18. Unable to read and speak English to a fluency level adequate for the full comprehension of procedures required in participation and consent. 19. Women with a history of toxic shock syndrome. 20. Women using an intrauterine device for contraception (as incompatible with softcup sampling) 21. Unlikely to comply with protocol.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Primary Safety Endpoint | From first dose until up to Week 22 | Number of participants experiencing a Grade 3 or above solicited local, systemic or laboratory adverse event, or any grade of adverse event leading to a clinical decision to discontinue immunizations, or any grade of unsolicited adverse event with onset within 7 days of immunization |
| Primary Immunogenicity | Week 22 | Magnitude of antigen-specific systemic IgG antibody binding responses (ng/mL) to CN54gp140 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Adverse Event Local to the Injection Sites, Starting Within 7 Days of Injection | 7 days after injection | Number of participants experiencing an adverse event local to the injection sites, starting within 7 days of injection |
Countries
United Kingdom
Participant flow
Recruitment details
Healthy volunteers were recruited
Pre-assignment details
All enrolled participants received at least one vaccination.
Participants by arm
| Arm | Count |
|---|---|
| Group 1: ID/EP + IM 0.6 mg DNA-C CN54ENV, intradermally with electroporation, at Weeks 0, 4 and 8. 2 mg DNA-C CN54ENV, intramuscularly without electroporation, at Weeks 0, 4 and 8.
50 µg CN54gp140, intradermally without electroporation, at Week 20. | 8 |
| Group 2: ID + IM/EP 0.6 mg DNA-C CN54ENV, intradermally without electroporation, at Weeks 0, 4 and 8.
2 mg DNA-C CN54ENV, intramuscularly with electroporation, at Weeks 0, 4 and 8. 50 µg CN54gp140, intradermally without electroporation, at Week 20. | 8 |
| Group 3: ID/EP + IM/EP 0.6 mg DNA-C CN54ENV, intradermally with electroporation, at Weeks 0, 4 and 8. 2 mg DNA-C CN54ENV, intramuscularly with electroporation, at Weeks 0, 4 and 8. 50 µg CN54gp140, intradermally without electroporation, at Week 20. | 8 |
| Total | 24 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Lost to Follow-up | 1 | 0 | 0 |
| Overall Study | Protocol Violation | 0 | 0 | 1 |
| Overall Study | Withdrawal by Subject | 0 | 0 | 2 |
Baseline characteristics
| Characteristic | Group 1: ID/EP + IM | Group 2: ID + IM/EP | Group 3: ID/EP + IM/EP | Total |
|---|---|---|---|---|
| Age, Continuous | 31 years | 27 years | 22 years | 27 years |
| Body Mass Index (BMI) | 24 kilograms per square metre | 21 kilograms per square metre | 25 kilograms per square metre | 24 kilograms per square metre |
| Body weight | 82 kilograms | 62 kilograms | 73 kilograms | 75 kilograms |
| Race/Ethnicity, Customized Other | 1 Participants | 3 Participants | 0 Participants | 4 Participants |
| Race/Ethnicity, Customized Other White | 1 Participants | 0 Participants | 2 Participants | 3 Participants |
| Race/Ethnicity, Customized White British | 6 Participants | 5 Participants | 6 Participants | 17 Participants |
| Region of Enrollment United Kingdom | 8 participants | 8 participants | 8 participants | 24 participants |
| Sex: Female, Male Female | 2 Participants | 2 Participants | 2 Participants | 6 Participants |
| Sex: Female, Male Male | 6 Participants | 6 Participants | 6 Participants | 18 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 9 | 0 / 8 | 0 / 11 |
| other Total, other adverse events | 0 / 9 | 0 / 8 | 1 / 11 |
| serious Total, serious adverse events | 0 / 9 | 0 / 8 | 1 / 11 |
Outcome results
Primary
Primary Immunogenicity
Magnitude of antigen-specific systemic IgG antibody binding responses (ng/mL) to CN54gp140
Time frame: Week 22
Population: All enrolled participants
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Group 1: ID/EP + IM | Primary Immunogenicity | 13934 nanograms per millilitre |
| Group 2: ID + IM/EP | Primary Immunogenicity | 11292 nanograms per millilitre |
| Group 3: ID/EP + IM/EP | Primary Immunogenicity | 31418 nanograms per millilitre |
Comparison: Kruskal-Wallis test with Dunn's correction for multiple comparisons to compare the levels of antigen-specific serum IgG in the three groups at Week 22.p-value: >0.05Kruskal-Wallis
Primary
Primary Safety Endpoint
Number of participants experiencing a Grade 3 or above solicited local, systemic or laboratory adverse event, or any grade of adverse event leading to a clinical decision to discontinue immunizations, or any grade of unsolicited adverse event with onset within 7 days of immunization
Time frame: From first dose until up to Week 22
Population: All enrolled participants
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Group 1: ID/EP + IM | Primary Safety Endpoint | 7 Participants |
| Group 2: ID + IM/EP | Primary Safety Endpoint | 8 Participants |
| Group 3: ID/EP + IM/EP | Primary Safety Endpoint | 10 Participants |
Comparison: The proportions of subjects with primary safety outcomes were compared in a pairwise manner between the three randomised groups, using Fisher's exact tests.p-value: >0.05Fisher Exact
Secondary
Adverse Event Local to the Injection Sites, Starting Within 7 Days of Injection
Number of participants experiencing an adverse event local to the injection sites, starting within 7 days of injection
Time frame: 7 days after injection
Population: Population does not include replacement participants
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Group 1: ID/EP + IM | Adverse Event Local to the Injection Sites, Starting Within 7 Days of Injection | 8 Participants |
| Group 2: ID + IM/EP | Adverse Event Local to the Injection Sites, Starting Within 7 Days of Injection | 8 Participants |
| Group 3: ID/EP + IM/EP | Adverse Event Local to the Injection Sites, Starting Within 7 Days of Injection | 8 Participants |