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Therapeutic Intensification Plus Immunomodulation to Decrease the HIV-1 Viral Reservoir (EraMune02)

Primary Purpose

HIV Infection

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
DNA + HIV-rAd5 vaccine
ART intensification (raltegravir)
ART intensification (maraviroc)
Sponsored by
Robert L. Murphy
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for HIV Infection focused on measuring HIV-1 infection, Treatment intensification, Immunomodulation, HIV-rAd5 vaccine

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • HIV-1 infection
  • At least 3 years of ART without interruption (less than one month cumulative)
  • ART regimen unchanged in the 3 months prior to screening
  • One HIV plasma viral load (RNA) documented at least 3 years prior to entry, and at least 2 HIV plasma viral load (RNA) documented per year thereafter
  • HIV plasma viral load (RNA) ≤ 500 copies/mL at least 3 years prior to entry, and HIV plasma viral load < 500 copies/mL for >90% of the measures thereafter
  • HIV plasma viral load (RNA) below the limit of detection for all values within the past year (one virologic blip allowed)
  • HIV plasma viral load below the limit of detection within 60 days of entry
  • CD4+ count ≥ 350 cells/mm3 within 60 days of entry
  • Proviral DNA ≥10 and ≤1000 copies/106 PBMCs within 75 days of entry
  • Adeno5 neutralizing antibody titers of 250 or less within 75 days of entry
  • Hemoglobin ≥ 10 g/dL within 60 days of entry
  • Platelets ≥ 100,000 per microliter within 60 days of entry
  • Hepatic transaminases (ALT and AST) ≤ 2.5 x ULN within 60 days of entry
  • Creatinine clearance > 50 mL/min by the Cockcroft-Gault equation within 60 days of entry

Exclusion Criteria:

  • Sexually active men and women who will not practice at least one form of barrier birth control (male partner using condoms, female partner using condoms, other barrier contraception, etc)
  • Pregnancy
  • Inability or unwillingness to provide informed consent
  • HBsAg positive
  • HCV antibody positive or HCV RNA detectable
  • Previous use of an integrase inhibitor (ie raltegravir) or a CCR5 inhibitor (ie maraviroc, vicriviroc). Use of raltegravir for non-treatment failure indications such as intensification or toxicity switches is allowed.
  • Immunologic therapeutic intervention (e.g. IL-2) within the past year
  • Participation in another clinical drug or device trial where the last dose of drug was within the past 30 days or an investigational medical device is currently implanted
  • Diagnosis of cancer within the last 5 years (except basal cell cutaneous cancers and cutaneous KS not requiring systemic therapy)
  • Co-morbid condition with an expected survival of less than 12 months
  • History of hypersensitivity to vaccination
  • History of autoimmune disease, such as systemic lupus erythematosis (SLE) or Hashimoto's thyroiditis
  • Active drug or alcohol use or dependence that, in the opinion of the site investigator, would interfere with adherence to study requirements

Sites / Locations

  • University of California San Francisco
  • Northwestern University
  • Cornell University

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

Maraviroc + raltegravir intensification

Maraviroc + raltegravir intens. plus DNA + HIV-rAd5 vaccine

Arm Description

ART Intensification (addition of raltegravir and maraviroc to suppressive ART for 56 weeks)

ART Intensification (addition of raltegravir and maraviroc for 56 weeks) PLUS immunomodulation therapy with DNA prime vaccine (Weeks 8,12,16) + HIV-recombinant Ad5-based vaccine (Week 32)

Outcomes

Primary Outcome Measures

Change From Baseline in HIV DNA in PBMCs at Week 56

Secondary Outcome Measures

Change From Baseline in HIV DNA in Rectal Tissue at Week 56
Change From Baseline in CD4+ T Cell Count at Week 56
HIV Specific T-cell Response to Env
HIV-specific immunity: Interferon gamma ELISpot response to Env (clades A) at week 36 (one month after rAd5 boosting)
Serious Adverse Events Attributed to Study Treatments
Grade 3 or 4 serious adverse events related to study treatments (raltegravir, maraviroc, or HIV-recombinant Ad5-based vaccine)

Full Information

First Posted
September 9, 2009
Last Updated
September 10, 2014
Sponsor
Robert L. Murphy
Collaborators
Objectif Recherche Vaccins SIDA, National Institute of Allergy and Infectious Diseases (NIAID), Pfizer, Merck Sharp & Dohme LLC
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1. Study Identification

Unique Protocol Identification Number
NCT00976404
Brief Title
Therapeutic Intensification Plus Immunomodulation to Decrease the HIV-1 Viral Reservoir
Acronym
EraMune02
Official Title
Multicenter, Randomized, Non-comparative, Controlled Study of Therapeutic Intensification Plus Immunomodulation in HIV-infected Patients With Long-term Viral Suppression
Study Type
Interventional

2. Study Status

Record Verification Date
September 2014
Overall Recruitment Status
Completed
Study Start Date
November 2009 (undefined)
Primary Completion Date
July 2013 (Actual)
Study Completion Date
June 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Robert L. Murphy
Collaborators
Objectif Recherche Vaccins SIDA, National Institute of Allergy and Infectious Diseases (NIAID), Pfizer, Merck Sharp & Dohme LLC

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The objective of this study is to discover a new approach in which human immunodeficiency virus (HIV) can be eradicated from an infected individual by intensified antiretroviral treatment coupled with immunomodulation. The hypothesis is that eradication is possible only if very potent antiretroviral drugs are delivered in conjunction with an immunomodulatory agent that simultaneously attack the viral reservoirs.
Detailed Description
The objective of this study is to measure the impact of immunomodulation plus treatment intensification on the HIV reservoir in HIV-infected patients who have viral suppression on combination antiretroviral therapy. Treatment regimens first will be intensified by the addition of raltegravir and maraviroc for 8 week followed by immunomodulation with the NIH HIV-rAd5 vaccine plus DNA prime-boost for 24 weeks. The primary endpoint is measurement of change in peripheral cellular HIV DNA. A decrease of 0.5 log is considered significant. A secondary endpoints include change in HIV DNA in the rectal mucosa, immunologic changes in the peripheral blood and safety.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HIV Infection
Keywords
HIV-1 infection, Treatment intensification, Immunomodulation, HIV-rAd5 vaccine

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
28 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Maraviroc + raltegravir intensification
Arm Type
Active Comparator
Arm Description
ART Intensification (addition of raltegravir and maraviroc to suppressive ART for 56 weeks)
Arm Title
Maraviroc + raltegravir intens. plus DNA + HIV-rAd5 vaccine
Arm Type
Experimental
Arm Description
ART Intensification (addition of raltegravir and maraviroc for 56 weeks) PLUS immunomodulation therapy with DNA prime vaccine (Weeks 8,12,16) + HIV-recombinant Ad5-based vaccine (Week 32)
Intervention Type
Biological
Intervention Name(s)
DNA + HIV-rAd5 vaccine
Intervention Description
4 mg subcutaneous injection at weeks 8 (DNA prime), 12 (DNA prime), 16 (DNA prime), and 32 (HIV-rAd5)
Intervention Type
Drug
Intervention Name(s)
ART intensification (raltegravir)
Other Intervention Name(s)
Isentress
Intervention Description
raltegravir 400 mg PO BID for 56 weeks
Intervention Type
Drug
Intervention Name(s)
ART intensification (maraviroc)
Other Intervention Name(s)
Selzentry, Celsentri
Intervention Description
maraviroc 150, 300, or 600 mg PO BID (depending on PK interactions with other medications) for 56 weeks
Primary Outcome Measure Information:
Title
Change From Baseline in HIV DNA in PBMCs at Week 56
Time Frame
56 weeks
Secondary Outcome Measure Information:
Title
Change From Baseline in HIV DNA in Rectal Tissue at Week 56
Time Frame
Week 56
Title
Change From Baseline in CD4+ T Cell Count at Week 56
Time Frame
Week 56
Title
HIV Specific T-cell Response to Env
Description
HIV-specific immunity: Interferon gamma ELISpot response to Env (clades A) at week 36 (one month after rAd5 boosting)
Time Frame
36 weeks
Title
Serious Adverse Events Attributed to Study Treatments
Description
Grade 3 or 4 serious adverse events related to study treatments (raltegravir, maraviroc, or HIV-recombinant Ad5-based vaccine)
Time Frame
56 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: HIV-1 infection At least 3 years of ART without interruption (less than one month cumulative) ART regimen unchanged in the 3 months prior to screening One HIV plasma viral load (RNA) documented at least 3 years prior to entry, and at least 2 HIV plasma viral load (RNA) documented per year thereafter HIV plasma viral load (RNA) ≤ 500 copies/mL at least 3 years prior to entry, and HIV plasma viral load < 500 copies/mL for >90% of the measures thereafter HIV plasma viral load (RNA) below the limit of detection for all values within the past year (one virologic blip allowed) HIV plasma viral load below the limit of detection within 60 days of entry CD4+ count ≥ 350 cells/mm3 within 60 days of entry Proviral DNA ≥10 and ≤1000 copies/106 PBMCs within 75 days of entry Adeno5 neutralizing antibody titers of 250 or less within 75 days of entry Hemoglobin ≥ 10 g/dL within 60 days of entry Platelets ≥ 100,000 per microliter within 60 days of entry Hepatic transaminases (ALT and AST) ≤ 2.5 x ULN within 60 days of entry Creatinine clearance > 50 mL/min by the Cockcroft-Gault equation within 60 days of entry Exclusion Criteria: Sexually active men and women who will not practice at least one form of barrier birth control (male partner using condoms, female partner using condoms, other barrier contraception, etc) Pregnancy Inability or unwillingness to provide informed consent HBsAg positive HCV antibody positive or HCV RNA detectable Previous use of an integrase inhibitor (ie raltegravir) or a CCR5 inhibitor (ie maraviroc, vicriviroc). Use of raltegravir for non-treatment failure indications such as intensification or toxicity switches is allowed. Immunologic therapeutic intervention (e.g. IL-2) within the past year Participation in another clinical drug or device trial where the last dose of drug was within the past 30 days or an investigational medical device is currently implanted Diagnosis of cancer within the last 5 years (except basal cell cutaneous cancers and cutaneous KS not requiring systemic therapy) Co-morbid condition with an expected survival of less than 12 months History of hypersensitivity to vaccination History of autoimmune disease, such as systemic lupus erythematosis (SLE) or Hashimoto's thyroiditis Active drug or alcohol use or dependence that, in the opinion of the site investigator, would interfere with adherence to study requirements
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Robert Murphy, MD
Organizational Affiliation
Northwestern University
Official's Role
Study Chair
Facility Information:
Facility Name
University of California San Francisco
City
San Francisco
State/Province
California
ZIP/Postal Code
94110
Country
United States
Facility Name
Northwestern University
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611
Country
United States
Facility Name
Cornell University
City
New York
State/Province
New York
ZIP/Postal Code
10011
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
26424549
Citation
Achenbach CJ, Assoumou L, Deeks SG, Wilkin TJ, Berzins B, Casazza JP, Lambert-Niclot S, Koup RA, Costagliola D, Calvez V, Katlama C, Autran B, Murphy RL; EraMune 02 study team. Effect of therapeutic intensification followed by HIV DNA prime and rAd5 boost vaccination on HIV-specific immunity and HIV reservoir (EraMune 02): a multicentre randomised clinical trial. Lancet HIV. 2015 Mar;2(3):e82-91. doi: 10.1016/S2352-3018(15)00026-0. Epub 2015 Feb 17.
Results Reference
derived

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Therapeutic Intensification Plus Immunomodulation to Decrease the HIV-1 Viral Reservoir

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