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Evaluating a Combination of Immune-based Therapies to Achieve a Remission of HIV Infection (HIVACAR)

Primary Purpose

HIV Infections

Status
Unknown status
Phase
Phase 1
Locations
Study Type
Interventional
Intervention
HIVACAR
placebo
Sponsored by
David Garcia Cinca
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

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

Eligibility Criteria

18 Years - 60 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Between ≥ 18 to <60 years of age
  2. Voluntarily signed informed consent
  3. Male, or female with negative pregnancy test prior to enrolment
  4. Proven HIV-1 infection (with positive antibodies against HIV-1 and a detectable plasma HIV-1 RNA before cART)
  5. Must be on stable treatment with cART for at least 18 months (cART is defined as an antiretroviral regimen consisting of at least three registered antiretroviral agents; periods of mono/dual antiretroviral therapy if not first time therapy and confirmed viral suppression during these periods of mono/dual therapy are permitted)
  6. Nadir CD4+ cell counts must be above or equal to 350 cells/µl, 2-3 occasional determinations below 350 cells/μl are allowed.
  7. Current CD4+ cell count must be at least 450 cells/µl
  8. HIV-RNA must be below 50 copies/ mL for the last 12 months prior to inclusion, during at least two measurements (occasional so called 'blips' up to 500 copies/mL are permitted)
  9. If male or female of childbearing potential willing to take correct contraceptive measures:

    1. If heterosexually active female; using an effective method of contraception from 14 days prior to the first vaccination until at least 12 weeks after the last vaccination; all female volunteers must be willing to undergo urine or serum pregnancy tests at time points specified in the Schedule of Procedures.
    2. If heterosexually active male; willing to use an effective method of contraception or agree on the use of an effective method of contraception by his partner from the day of the first vaccination until 12 weeks after the last vaccination.
  10. If sexually active, willing to use a reliable method of reducing the risk of transmission to their sexual partners during treatment interruption (which could include pre-exposure prophylaxis [PrEP] for their sexual partners)

Exclusion Criteria:

  1. Treatment with a non-cART regimen of antiretroviral agents prior to the start of any antiretroviral regimen
  2. History of a CDC class C event (see Appendix IV)
  3. Women of childbearing potential with a positive pregnancy test, or participants (male or female) who wish to plan a pregnancy during the trial period.
  4. Active opportunistic infection, or any active infection or malignancy within 30 days prior to screening visit
  5. Therapy with immunomodulatory agents, including cytokines (e.g. IL2) and gamma globulin, or cytostatic chemotherapy within 90 days prior to screening visit
  6. Use of anti-coagulant medication
  7. Use of any investigational drug during the 90 days prior to study entry
  8. Previous antiretroviral therapy failure and/or mutations conferring genotypic resistance to antiretroviral therapy
  9. Participants with severe cardiovascular diseases or long QT interval
  10. Active hepatitis C virus
  11. Hepatitis B infection
  12. Treatment with strong inhibitors or inducers of CYP3A4, except protease inhibitors for HIV treatment (see protocol section 5.7); if in treatment of protease inhibitors for HIV not willing to change inhibitor protease for an integrase inhibitor during the study.
  13. Any known allergy or intolerance to any of the study drugs or excipient
  14. Protein egg allergy
  15. Known past history of clinical Epstein-Barr Virus (EBV) infection or recurrent herpes zoster
  16. Hematologic abnormalities ≥Grade 1
  17. Potassium or magnesium levels outside the upper limit of normal (ULN) and lower limit of normal (LLN)
  18. History of autoimmune disorders as multiple sclerosis.
  19. Any other condition which, in the opinion of the investigator, may interfere with the evaluation of the study objectives

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    Placebo Comparator

    Arm Label

    HIVACAR

    Placebo

    Arm Description

    Participants will receive 5 vaccines of personalized RNA vaccine (HIVACAR01), 2 dose of 10-1074 antibodies and 3 doses of romidepsin

    Participants will receive 5 doses of placebo, 2 doses of 10-1074 antibodies and 3 doses of romidepsin

    Outcomes

    Primary Outcome Measures

    Grade 3 or above severe local , systemic, clinical or laboratory adverse event t
    Local adverse events may be pain, cutaneous reactions including induration and systemic emperature, chills, headache, nausea, vomiting, malaise, and myalgia. Clinical and laboratory must be confirmed at examination or on repeat testing respectively. Any adverse event attributable to the combination therapy leading to discontinuation of the study treatmen

    Secondary Outcome Measures

    Proportion of participants who maintain an undetectable viral load
    defined as a viral load below the threshold of 50 copies/ml
    Percentage of participants with control of viral load below detectable level
    Change from baseline in total proviral HIV-1 DNA per 10^6 CD4+ T cells.
    Change from baseline in integrated proviral HIV-1 DNA per 10^6 CD4+ T cells.
    Change from baseline in HIV-1 transcription.
    According to CA US HIV-1 RNA measured in unfractionated CD4+ T cells
    Change in plasma HIV-1 RNA from baseline
    Breadth and magnitude of CD4+ HIV-specific T cell responses measured by IFN-gamma ELISPOT compared with baseline.
    Breadth and magnitude of CD8+ HIV-specific T cell responses measured by IFN-gamma ELISPOT compared with baseline.
    Breadth and magnitude of CD4+ HIV-specific T cell responses measured by Intra-cellular cytokine staining-ICS in the study arms as compared with baseline.
    Breadth and magnitude of CD8+ HIV-specific T cell responses measured by Intra-cellular cytokine staining-ICS in the study arms as compared with baseline.
    Change from baseline in CD8+ T-cell HIV suppressive capacity.
    Change from baseline in T cell activation markers
    Change from baseline in T cell activation markers
    Change from baseline in T cell activation markers
    Change from baseline in T cell subset distribution
    Change from baseline in T cell subset distribution
    Change from baseline in T cell subset distribution
    Change from baseline in PD-1 expression
    Evaluate fecal microbiome
    Characterise viral escape from vaccine-induced immune T cell responses
    Comparison of viral sequences pre-cART and rebounding after cART interruption
    Analysis of changes in sensitivity to neutralisation by 10-1074 of rebounding viruses after cART interruption to identify neutralisation escape mutants.
    To evaluate mRNA expression profiles in whole PBMC at baseline

    Full Information

    First Posted
    March 14, 2018
    Last Updated
    March 27, 2020
    Sponsor
    David Garcia Cinca
    Collaborators
    IDIBAPS - Institut d'Investigacions Biomèdiques August Pi i Sunyer, Felipe García - Investigator Coordinator
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    1. Study Identification

    Unique Protocol Identification Number
    NCT03619278
    Brief Title
    Evaluating a Combination of Immune-based Therapies to Achieve a Remission of HIV Infection
    Acronym
    HIVACAR
    Official Title
    A Phase I/IIa, Randomised Study to Evaluate the Safety and the Effectiveness of a Combination of Therapeutic Vaccine, Broadly Neutralising Antibody (10-1074), and the Latency Reversing Agent Romidepsin to Achieve a Remission of HIV Infection in Chronically HIV-infected Participants Under Stable Combined Antiretroviral Therapy.
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    March 2020
    Overall Recruitment Status
    Unknown status
    Study Start Date
    November 1, 2020 (Anticipated)
    Primary Completion Date
    July 15, 2021 (Anticipated)
    Study Completion Date
    July 15, 2021 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor-Investigator
    Name of the Sponsor
    David Garcia Cinca
    Collaborators
    IDIBAPS - Institut d'Investigacions Biomèdiques August Pi i Sunyer, Felipe García - Investigator Coordinator

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No
    Data Monitoring Committee
    Yes

    5. Study Description

    Brief Summary
    A phase I/IIa, multinational, multicentric (IDIBAPS, IRSICAIXA, AARHUS, VUB, APHP), randomised, balanced by centre (to include participants from the 4 arms), open-label, controlled clinical trial. Each participant will be followed up a different time according to study arm: a minimum of 38 weeks in arm I, 31 weeks in arm II, 54 weeks in arm III and 26 weeks in the arm 4. The study duration will be 104 weeks from inclusion of the first participant. Participants will be randomised to one of the following 4 arms: Arm 1 (study): 14 participants will receive 3 vaccines of HIVARNA01.3 prime, 2 MVA-vectored vaccine boosts, 1 dose of 10-1074 antibodies and 3 doses of romidepsin Arm 2 (study): 14 participants will receive 5 vaccines of HIVARNA01.3, 1 dose of 10-1074 antibodies and 3 doses of romidepsin Arm 3 (study): 14 participants will receive 5 vaccines of personalized RNA vaccine (HIVACAR01), 1 dose of 10-1074 antibodies and 3 doses of romidepsin Arm 4 (control): 14 participants 1 dose of 10-1074 antibodies and 3 doses of romidepsin

    6. Conditions and Keywords

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

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 1, Phase 2
    Interventional Study Model
    Parallel Assignment
    Masking
    ParticipantCare ProviderInvestigator
    Masking Description
    Placebo
    Allocation
    Randomized
    Enrollment
    12 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    HIVACAR
    Arm Type
    Experimental
    Arm Description
    Participants will receive 5 vaccines of personalized RNA vaccine (HIVACAR01), 2 dose of 10-1074 antibodies and 3 doses of romidepsin
    Arm Title
    Placebo
    Arm Type
    Placebo Comparator
    Arm Description
    Participants will receive 5 doses of placebo, 2 doses of 10-1074 antibodies and 3 doses of romidepsin
    Intervention Type
    Other
    Intervention Name(s)
    HIVACAR
    Intervention Description
    Participants will receive 5 vaccines of personalized RNA vaccine (HIVACAR01), 2 doses of 10-1074 antibodies and 3 doses of romidepsin
    Intervention Type
    Other
    Intervention Name(s)
    placebo
    Intervention Description
    Participants will receive 5 vaccines of placebo of HIVACAR01, 2 doses of 10-1074 antibodies and 3 doses of romidepsin
    Primary Outcome Measure Information:
    Title
    Grade 3 or above severe local , systemic, clinical or laboratory adverse event t
    Description
    Local adverse events may be pain, cutaneous reactions including induration and systemic emperature, chills, headache, nausea, vomiting, malaise, and myalgia. Clinical and laboratory must be confirmed at examination or on repeat testing respectively. Any adverse event attributable to the combination therapy leading to discontinuation of the study treatmen
    Time Frame
    12 days (28 days after each inmuisation)
    Secondary Outcome Measure Information:
    Title
    Proportion of participants who maintain an undetectable viral load
    Description
    defined as a viral load below the threshold of 50 copies/ml
    Time Frame
    12 weeks (after discontinuation of antiretroviral therapy)
    Title
    Percentage of participants with control of viral load below detectable level
    Time Frame
    24 weeks (after discontinuation of antiretroviral therapy)
    Title
    Change from baseline in total proviral HIV-1 DNA per 10^6 CD4+ T cells.
    Time Frame
    up to 51 weeks
    Title
    Change from baseline in integrated proviral HIV-1 DNA per 10^6 CD4+ T cells.
    Time Frame
    up to 51 weeks
    Title
    Change from baseline in HIV-1 transcription.
    Description
    According to CA US HIV-1 RNA measured in unfractionated CD4+ T cells
    Time Frame
    up to 39 weeks
    Title
    Change in plasma HIV-1 RNA from baseline
    Time Frame
    up to 39 weeks
    Title
    Breadth and magnitude of CD4+ HIV-specific T cell responses measured by IFN-gamma ELISPOT compared with baseline.
    Time Frame
    up to 27 weeks
    Title
    Breadth and magnitude of CD8+ HIV-specific T cell responses measured by IFN-gamma ELISPOT compared with baseline.
    Time Frame
    up to 27 weeks
    Title
    Breadth and magnitude of CD4+ HIV-specific T cell responses measured by Intra-cellular cytokine staining-ICS in the study arms as compared with baseline.
    Time Frame
    up to 27 weeks
    Title
    Breadth and magnitude of CD8+ HIV-specific T cell responses measured by Intra-cellular cytokine staining-ICS in the study arms as compared with baseline.
    Time Frame
    up to 27 weeks
    Title
    Change from baseline in CD8+ T-cell HIV suppressive capacity.
    Time Frame
    up to 51 weeks
    Title
    Change from baseline in T cell activation markers
    Time Frame
    up to 29 weeks
    Title
    Change from baseline in T cell activation markers
    Time Frame
    3 weeeks
    Title
    Change from baseline in T cell activation markers
    Time Frame
    up to 24 weeks
    Title
    Change from baseline in T cell subset distribution
    Time Frame
    up to 29 weeks
    Title
    Change from baseline in T cell subset distribution
    Time Frame
    14 weeks
    Title
    Change from baseline in T cell subset distribution
    Time Frame
    up to 27 weeks
    Title
    Change from baseline in PD-1 expression
    Time Frame
    up to 51 weeks
    Title
    Evaluate fecal microbiome
    Time Frame
    baseline and at week 14
    Title
    Characterise viral escape from vaccine-induced immune T cell responses
    Description
    Comparison of viral sequences pre-cART and rebounding after cART interruption
    Time Frame
    up to 51 weeks
    Title
    Analysis of changes in sensitivity to neutralisation by 10-1074 of rebounding viruses after cART interruption to identify neutralisation escape mutants.
    Time Frame
    up to 51 weeks
    Title
    To evaluate mRNA expression profiles in whole PBMC at baseline
    Time Frame
    at first romidepsin administration and 14 and 26 weeks after first romidepsin administration

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    60 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Between ≥ 18 to <60 years of age Voluntarily signed informed consent Male, or female with negative pregnancy test prior to enrolment Proven HIV-1 infection (with positive antibodies against HIV-1 and a detectable plasma HIV-1 RNA before cART) Must be on stable treatment with cART for at least 18 months (cART is defined as an antiretroviral regimen consisting of at least three registered antiretroviral agents; periods of mono/dual antiretroviral therapy if not first time therapy and confirmed viral suppression during these periods of mono/dual therapy are permitted) Nadir CD4+ cell counts must be above or equal to 350 cells/µl, 2-3 occasional determinations below 350 cells/μl are allowed. Current CD4+ cell count must be at least 450 cells/µl HIV-RNA must be below 50 copies/ mL for the last 12 months prior to inclusion, during at least two measurements (occasional so called 'blips' up to 500 copies/mL are permitted) If male or female of childbearing potential willing to take correct contraceptive measures: If heterosexually active female; using an effective method of contraception from 14 days prior to the first vaccination until at least 12 weeks after the last vaccination; all female volunteers must be willing to undergo urine or serum pregnancy tests at time points specified in the Schedule of Procedures. If heterosexually active male; willing to use an effective method of contraception or agree on the use of an effective method of contraception by his partner from the day of the first vaccination until 12 weeks after the last vaccination. If sexually active, willing to use a reliable method of reducing the risk of transmission to their sexual partners during treatment interruption (which could include pre-exposure prophylaxis [PrEP] for their sexual partners) Exclusion Criteria: Treatment with a non-cART regimen of antiretroviral agents prior to the start of any antiretroviral regimen History of a CDC class C event (see Appendix IV) Women of childbearing potential with a positive pregnancy test, or participants (male or female) who wish to plan a pregnancy during the trial period. Active opportunistic infection, or any active infection or malignancy within 30 days prior to screening visit Therapy with immunomodulatory agents, including cytokines (e.g. IL2) and gamma globulin, or cytostatic chemotherapy within 90 days prior to screening visit Use of anti-coagulant medication Use of any investigational drug during the 90 days prior to study entry Previous antiretroviral therapy failure and/or mutations conferring genotypic resistance to antiretroviral therapy Participants with severe cardiovascular diseases or long QT interval Active hepatitis C virus Hepatitis B infection Treatment with strong inhibitors or inducers of CYP3A4, except protease inhibitors for HIV treatment (see protocol section 5.7); if in treatment of protease inhibitors for HIV not willing to change inhibitor protease for an integrase inhibitor during the study. Any known allergy or intolerance to any of the study drugs or excipient Protein egg allergy Known past history of clinical Epstein-Barr Virus (EBV) infection or recurrent herpes zoster Hematologic abnormalities ≥Grade 1 Potassium or magnesium levels outside the upper limit of normal (ULN) and lower limit of normal (LLN) History of autoimmune disorders as multiple sclerosis. Any other condition which, in the opinion of the investigator, may interfere with the evaluation of the study objectives
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Felipe Garcia, MD
    Phone
    +93.227.54.00
    Email
    fgarcia@clinic.cat
    First Name & Middle Initial & Last Name or Official Title & Degree
    Florencia Etcheverry
    Phone
    +93.227.54.00
    Email
    MFETCHEV@clinic.cat

    12. IPD Sharing Statement

    Plan to Share IPD
    Undecided

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    Evaluating a Combination of Immune-based Therapies to Achieve a Remission of HIV Infection

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