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Safety and Therapeutic Efficacy of the VRC01 Antibody in Patients Who Initiated Antiretroviral Therapy During Early Acute HIV Infection

Primary Purpose

HIV Infections

Status
Completed
Phase
Phase 2
Locations
Thailand
Study Type
Interventional
Intervention
VRC01
Placebo for VRC01
Sponsored by
National Institute of Allergy and Infectious Diseases (NIAID)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for HIV Infections focused on measuring Human Monoclonal Antibody

Eligibility Criteria

20 Years - 50 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Able and willing to provide written informed consent or, in the case of illiteracy, witnessed verbal informed consent with documentation of a thumbprint in lieu of a signature.
  • Passes Test of Understanding.
  • Man or woman aged 20-50 years.
  • Initiated on ART during acute HIV infection (Fiebig Stage I to III at RV 254 enrollment).
  • Prescribed ART for at least 24 months prior to enrollment.
  • HIV-1 RNA less than 50 copies/mL on at least three consecutive measurements within the past 12 months.
  • Integrated HIV DNA in peripheral blood mononuclear cells (PBMCs) below the level of detection (1 copy/10^5 PBMCs) within 6 months prior to enrollment.
  • Last documented peripheral blood CD4 greater than 400 cells/mm^3 within 3 months prior to enrollment.
  • No HIV-related or AIDS-defining illness within 6 months prior to enrollment.
  • In general good health.
  • Able to participate in study visits.

Female-Specific Criteria:

  • Agrees not to become pregnant from the time of study enrollment until the last study visit. If a woman is sexually active and has no history of hysterectomy or tubal ligation or menopause, she must agree to use a prescription birth control method or a barrier birth control method.
  • Negative beta-human chorionic gonadotropin (β-HCG) pregnancy test (urine or serum) on day of enrollment for any women unless she is post-menopause for 24 consecutive months or has undergone a surgical procedure that precludes pregnancy.

Exclusion Criteria:

  • Previous receipt of humanized or human monoclonal antibody whether licensed or investigational.
  • Ongoing AIDS-related opportunistic infection (including oral thrush).
  • Active injection drug use within previous 12 months.
  • History of a severe allergic reaction with generalized urticaria, angioedema, or anaphylaxis in the 2 years prior to enrollment.
  • History of chronic urticaria requiring daily treatment.
  • Physical finding on examination considered indicative of significant disease such as murmur (other than functional), hepatosplenomegaly, or focal neurologic deficit.
  • Hypertension that is not well controlled by medication.
  • Hepatitis B surface antigen positive at any time in the past.
  • Hepatitis C antibody positive at any time in the past.
  • Untreated syphilis.
  • Estimated glomerular filtration rate (GFR) less than 50 ml/min within the past 90 days.
  • Pregnant or breastfeeding.
  • Receipt of licensed vaccine or other investigational study agent within 28 days prior to enrollment or past participation in an investigational HIV vaccine study with receipt of active product.
  • Current or planned participation in another interventional clinical trial during the study period.
  • Chronic or recurrent use of medications that modify host immune response, e.g., oral or parenteral steroids, cancer chemotherapy.
  • Any other chronic or clinically significant medical condition that in the opinion of investigator would jeopardize the safety or rights of the volunteer. Including, but not limited to: diabetes mellitus type I, chronic hepatitis, renal failure; OR clinically significant forms of: drug or alcohol abuse, mental illness, severe asthma, autoimmune disease, psychiatric disorders, heart disease, or cancer.
  • Study site employee.

Sites / Locations

  • SEARCH Thai Red Cross AIDS Research Centre Non-Network CRS

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

VRC01

Placebo for VRC01

Arm Description

Participants will receive an intravenous (IV) infusion of 40 mg/kg of VRC01 at Week 0 and every 3 weeks until Week 24 or until criteria for resumption of ART are met.

Participants will receive an IV infusion of placebo at Week 0 and every 3 weeks until Week 24 or until criteria for resumption of ART are met.

Outcomes

Primary Outcome Measures

Number of Participants With Serious Adverse Event
Participants were monitored for up to 10 weeks after the last infusion of VRC01 or placebo
Number of Participants With Sustained Virologic Suppression
Number of participants who sustained virologic control (HIV RNA <50 copies/mL), without indication for ART resumption at week 24.

Secondary Outcome Measures

Time to Viral Rebound After Cessation of ART
This is the days from Analytic Treatment Interruption (ATI) to: HIV RNA >= 20 copies/mL. HIV RNA >= 1000 copies/mL
Level of Rebound Viremia After Cessation of ART
This is the HIV-1 RNA levels (copies/mL) at first detection and ART resumption.
Time to ART Resumption for Any Reason After Cessation of ART
This is the days from ATI to ART resumptions.
Number of Participants With Detectable HIV-1 RNA Via Single Copy Assay
This is number of participants who had detectable HIV-1 RNA via the ultrasensitive single copy assay prior to detectability on the routine assay.
Change in CD4+ T Cell Count From ATI to ART Resumption
This is change in CD4+ T cell count from ATI to ART resumption.
Total HIV DNA in the Peripheral Compartment
This is total HIV DNA levels at baseline ATI, ART resumption and 6 month after ART resumption
Number of Participants Hospitalized.
Participants were monitored for up to 10 weeks after the last infusion of VRC01 or placebo
Number of Participants With Acute Retroviral Syndrome (ARS)
This is the number of participants who have developed during ATI.
Neuropsychological Battery Performance
This is a NPZ-4 score,a 4-test NP battery evaluated fine motor function/manual dexterity [Grooved Pegboard test (GP), non-dominant hand], psychomotor speed [Color Trails 1 (CT1), Trail Making A (TM)], and executive function/set shifting [Color Trails 2 (CT2)]. Individual test raw scores were converted to z-scores. Z-scores range from -3 standard deviations up to +3 standard deviations. Higher scores indicate better test performance and lower cognitive impairment.
Computed Score on the Control and Attention Task (i.e., Flanker Task)
The Flanker is a measure of executive function, specifically tapping inhibitory control and attention.The scores range from 0 to 10. A higher scores indicate higher levels of ability to attend to relevant stimuli and inhibit attention from irrelevant stimuli.

Full Information

First Posted
January 20, 2016
Last Updated
October 29, 2021
Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
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1. Study Identification

Unique Protocol Identification Number
NCT02664415
Brief Title
Safety and Therapeutic Efficacy of the VRC01 Antibody in Patients Who Initiated Antiretroviral Therapy During Early Acute HIV Infection
Official Title
Safety and Therapeutic Efficacy of the Broadly Neutralizing HIV-1 Specific Monoclonal Antibody VRC01 During Analytic Treatment Interruption in Patients Who Initiated Antiretroviral Therapy During Early Acute HIV Infection
Study Type
Interventional

2. Study Status

Record Verification Date
October 2021
Overall Recruitment Status
Completed
Study Start Date
August 2016 (undefined)
Primary Completion Date
August 4, 2017 (Actual)
Study Completion Date
August 4, 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The study will evaluate the safety and therapeutic efficacy of the human monoclonal antibody (mAb) VRC-HIVMAB060-00-AB (VRC01), when administered during analytic treatment interruption (ATI), in adults who began antiretroviral therapy (ART) during early acute HIV infection.
Detailed Description
Human monoclonal antibodies (mAbs) may have the potential to treat HIV infection by preventing the spread of the virus. This study will evaluate an experimental mAb known as VRC-HIVMAB060-00-AB (VRC01). The purpose of this study is to evaluate the safety and therapeutic efficacy of VRC01, when administered during analytic treatment interruption (ATI), in adults who began antiretroviral therapy (ART) during early acute HIV infection. The study will enroll participants from the RV 254 study who were diagnosed during early acute HIV infection and who have been on ART. At study entry, participants will stop taking their antiretroviral (ARV) medications. They will be randomly assigned to receive an intravenous (IV) infusion of VRC01 or placebo at Weeks 0 (study entry), 3, 6, 9, 12, 15, 18, 21, and 24. For 7 days following each infusion, participants will be asked to record and report any symptoms to study researchers. In addition to the infusion visits, participants will attend follow-up visits for 48 weeks. Study visits may include physical examinations, blood collection, and urine collection. Neurocognitive testing will take place at select study visits. Some participants may take part in optional study procedures including mucosal secretion collection, MRI brain scan, colon biopsy, lymph node biopsy, leukapheresis, and lumbar puncture. Study staff will monitor participants' HIV throughout the study, and participants will end their participation in the study and restart their ARV medications, if needed.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HIV Infections
Keywords
Human Monoclonal Antibody

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
23 (Actual)

8. Arms, Groups, and Interventions

Arm Title
VRC01
Arm Type
Experimental
Arm Description
Participants will receive an intravenous (IV) infusion of 40 mg/kg of VRC01 at Week 0 and every 3 weeks until Week 24 or until criteria for resumption of ART are met.
Arm Title
Placebo for VRC01
Arm Type
Placebo Comparator
Arm Description
Participants will receive an IV infusion of placebo at Week 0 and every 3 weeks until Week 24 or until criteria for resumption of ART are met.
Intervention Type
Biological
Intervention Name(s)
VRC01
Other Intervention Name(s)
VRC-HIVMAB060-00-AB
Intervention Description
40 mg/kg; administered IV
Intervention Type
Biological
Intervention Name(s)
Placebo for VRC01
Intervention Description
Sodium Chloride for Injection 0.9%, USP; administered IV
Primary Outcome Measure Information:
Title
Number of Participants With Serious Adverse Event
Description
Participants were monitored for up to 10 weeks after the last infusion of VRC01 or placebo
Time Frame
Measured up to 10 weeks after last infusion of VRC01 or placebo
Title
Number of Participants With Sustained Virologic Suppression
Description
Number of participants who sustained virologic control (HIV RNA <50 copies/mL), without indication for ART resumption at week 24.
Time Frame
Measured through 24 weeks after ATI
Secondary Outcome Measure Information:
Title
Time to Viral Rebound After Cessation of ART
Description
This is the days from Analytic Treatment Interruption (ATI) to: HIV RNA >= 20 copies/mL. HIV RNA >= 1000 copies/mL
Time Frame
Measured from Baseline ATI through ART resumption.
Title
Level of Rebound Viremia After Cessation of ART
Description
This is the HIV-1 RNA levels (copies/mL) at first detection and ART resumption.
Time Frame
Measured from Baseline ATI through ART resumption.
Title
Time to ART Resumption for Any Reason After Cessation of ART
Description
This is the days from ATI to ART resumptions.
Time Frame
Measured from Baseline ATI through ART resumption.
Title
Number of Participants With Detectable HIV-1 RNA Via Single Copy Assay
Description
This is number of participants who had detectable HIV-1 RNA via the ultrasensitive single copy assay prior to detectability on the routine assay.
Time Frame
Measured from Baseline ATI through ART resumption.
Title
Change in CD4+ T Cell Count From ATI to ART Resumption
Description
This is change in CD4+ T cell count from ATI to ART resumption.
Time Frame
Measured from Baseline ATI through ART resumption
Title
Total HIV DNA in the Peripheral Compartment
Description
This is total HIV DNA levels at baseline ATI, ART resumption and 6 month after ART resumption
Time Frame
Measured from ATI through 6 months after ART resumption
Title
Number of Participants Hospitalized.
Description
Participants were monitored for up to 10 weeks after the last infusion of VRC01 or placebo
Time Frame
Measured up to 10 weeks after the last infusion of VRC01 or placebo
Title
Number of Participants With Acute Retroviral Syndrome (ARS)
Description
This is the number of participants who have developed during ATI.
Time Frame
Measured from Baseline ATI through ART resumption.
Title
Neuropsychological Battery Performance
Description
This is a NPZ-4 score,a 4-test NP battery evaluated fine motor function/manual dexterity [Grooved Pegboard test (GP), non-dominant hand], psychomotor speed [Color Trails 1 (CT1), Trail Making A (TM)], and executive function/set shifting [Color Trails 2 (CT2)]. Individual test raw scores were converted to z-scores. Z-scores range from -3 standard deviations up to +3 standard deviations. Higher scores indicate better test performance and lower cognitive impairment.
Time Frame
Measured from Baseline ATI through ART resumption.
Title
Computed Score on the Control and Attention Task (i.e., Flanker Task)
Description
The Flanker is a measure of executive function, specifically tapping inhibitory control and attention.The scores range from 0 to 10. A higher scores indicate higher levels of ability to attend to relevant stimuli and inhibit attention from irrelevant stimuli.
Time Frame
Measured from Baseline ATI through ART resumption.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
20 Years
Maximum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Able and willing to provide written informed consent or, in the case of illiteracy, witnessed verbal informed consent with documentation of a thumbprint in lieu of a signature. Passes Test of Understanding. Man or woman aged 20-50 years. Initiated on ART during acute HIV infection (Fiebig Stage I to III at RV 254 enrollment). Prescribed ART for at least 24 months prior to enrollment. HIV-1 RNA less than 50 copies/mL on at least three consecutive measurements within the past 12 months. Integrated HIV DNA in peripheral blood mononuclear cells (PBMCs) below the level of detection (1 copy/10^5 PBMCs) within 6 months prior to enrollment. Last documented peripheral blood CD4 greater than 400 cells/mm^3 within 3 months prior to enrollment. No HIV-related or AIDS-defining illness within 6 months prior to enrollment. In general good health. Able to participate in study visits. Female-Specific Criteria: Agrees not to become pregnant from the time of study enrollment until the last study visit. If a woman is sexually active and has no history of hysterectomy or tubal ligation or menopause, she must agree to use a prescription birth control method or a barrier birth control method. Negative beta-human chorionic gonadotropin (β-HCG) pregnancy test (urine or serum) on day of enrollment for any women unless she is post-menopause for 24 consecutive months or has undergone a surgical procedure that precludes pregnancy. Exclusion Criteria: Previous receipt of humanized or human monoclonal antibody whether licensed or investigational. Ongoing AIDS-related opportunistic infection (including oral thrush). Active injection drug use within previous 12 months. History of a severe allergic reaction with generalized urticaria, angioedema, or anaphylaxis in the 2 years prior to enrollment. History of chronic urticaria requiring daily treatment. Physical finding on examination considered indicative of significant disease such as murmur (other than functional), hepatosplenomegaly, or focal neurologic deficit. Hypertension that is not well controlled by medication. Hepatitis B surface antigen positive at any time in the past. Hepatitis C antibody positive at any time in the past. Untreated syphilis. Estimated glomerular filtration rate (GFR) less than 50 ml/min within the past 90 days. Pregnant or breastfeeding. Receipt of licensed vaccine or other investigational study agent within 28 days prior to enrollment or past participation in an investigational HIV vaccine study with receipt of active product. Current or planned participation in another interventional clinical trial during the study period. Chronic or recurrent use of medications that modify host immune response, e.g., oral or parenteral steroids, cancer chemotherapy. Any other chronic or clinically significant medical condition that in the opinion of investigator would jeopardize the safety or rights of the volunteer. Including, but not limited to: diabetes mellitus type I, chronic hepatitis, renal failure; OR clinically significant forms of: drug or alcohol abuse, mental illness, severe asthma, autoimmune disease, psychiatric disorders, heart disease, or cancer. Study site employee.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Trevor Crowell, MD, PhD
Organizational Affiliation
US Military HIV Research Program
Official's Role
Study Chair
Facility Information:
Facility Name
SEARCH Thai Red Cross AIDS Research Centre Non-Network CRS
City
Bangkok
ZIP/Postal Code
10330
Country
Thailand

12. IPD Sharing Statement

Citations:
PubMed Identifier
31000477
Citation
Crowell TA, Colby DJ, Pinyakorn S, Sacdalan C, Pagliuzza A, Intasan J, Benjapornpong K, Tangnaree K, Chomchey N, Kroon E, de Souza MS, Tovanabutra S, Rolland M, Eller MA, Paquin-Proulx D, Bolton DL, Tokarev A, Thomas R, Takata H, Trautmann L, Krebs SJ, Modjarrad K, McDermott AB, Bailer RT, Doria-Rose N, Patel B, Gorelick RJ, Fullmer BA, Schuetz A, Grandin PV, O'Connell RJ, Ledgerwood JE, Graham BS, Tressler R, Mascola JR, Chomont N, Michael NL, Robb ML, Phanuphak N, Ananworanich J; RV397 Study Group. Safety and efficacy of VRC01 broadly neutralising antibodies in adults with acutely treated HIV (RV397): a phase 2, randomised, double-blind, placebo-controlled trial. Lancet HIV. 2019 May;6(5):e297-e306. doi: 10.1016/S2352-3018(19)30053-0. Epub 2019 Apr 15.
Results Reference
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Safety and Therapeutic Efficacy of the VRC01 Antibody in Patients Who Initiated Antiretroviral Therapy During Early Acute HIV Infection

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