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iHIVARNA Clinical Trial in HIV Infected Individuals (iHIVARNA-01)

Primary Purpose

HIV Infections

Status
Terminated
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
iHIVARNA-01
TriMix
Placebo
Sponsored by
Rob Gruters
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for HIV Infections focused on measuring Immunotherapy, mRNA, Lentivirus infection, Virus disease, Sexually transmitted disease, Immunodeficiency syndrome

Eligibility Criteria

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

Inclusion Criteria:

  1. ≥ 18 years of age;
  2. Voluntarily signed informed consent;
  3. Proven HIV-1 infection (with documented antibodies against HIV-1 and a detectable plasma HIV-1 RNA before initiation of therapy);
  4. On stable treatment with cART regimen (antiretroviral therapy consisting of at least three registered antiretroviral agents) for at least 3 years;
  5. Nadir CD4+ ≥ 350 cells/μl (up to 2 occasional determinations ≤ 350 cells/μl are allowed);
  6. Current CD4+ cell count ≥ 450 cells/μl;
  7. HIV-RNA below 50 copies/mL in the last 6 months prior to randomization, during at least two measurements (occasional so called 'blips' ≤ 500 copies/mL are permitted);
  8. If sexually active, willing to use a reliable method of reducing the risk of transmission to their sexual partners during treatment interruption (including PrEP).

    1. For heterosexually active female, using an effective method of contraception with partner (combined oral contraceptive pill; injectable or implanted contraceptive; IUD/IUS; consistent record with condoms; physiological or anatomical sterility (in self or partner) from 14 days prior to the first vaccination until 4 months after the last vaccination.

For heterosexually active male, using an effective method of contraception with their partner from the first day of vaccination until 4 months after the last vaccination. -

Exclusion Criteria:

  1. Treatment with non-cART regimen prior to cART regimen;
  2. Previous failure to antiretroviral and/or mutations conferring genotypic resistance to antiretroviral therapy;
  3. Non-subtype B HIV infection;
  4. Active Hepatitis B virus and/or Hepatitis C virus co-infection;
  5. History of a CDC class C event (see appendix A);
  6. Pregnant female (screened with a positive pregnancy test), lactating or intending to become pregnant during the study;
  7. Active malignancy ≤ 30 days (extended period on the clinical assessment of the investigator) prior to screening;
  8. Active infection with fever (38°C or above) ≤ 10 days of screening and/or first vaccination;
  9. Therapy with immunomodulatory agents (e.g. systemic corticosteroids), including cytokines (e.g. IL-2), immunoglobulins and/or cytostatic chemotherapy ≤ 90 days prior to screening. This does not include seasonal influenza, hepatitis B and/or other travel related vaccines;
  10. Congenital, acquired or induced coagulation disorders, such as thrombocytopenia (thrombocytes < 150x109/L) and/or current use of anti-coagulant medication (e.g. coumarins, inhibitors of Xa); Usage of NSAIDs (including acetylsalicylic acid) is allowed, however it is advised to interrupt therapy 10 days ahead of vaccination;
  11. Usage of any investigational drug ≤ 90 days prior to study entry;
  12. An employee of the investigator or study site, with direct involvement in the proposed study or other studies under the direction of that investigator or study site, or is a family member of an employee or the investigator Any other condition, which, in the opinion of the investigator, may interfere with the evaluation of the study objectives

Sites / Locations

  • Institute for Tropical Medicine
  • UZ Brussel
  • Erasmus MC
  • Hospital Universitari Germans Trias i Pujol
  • Hospital Clinic

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Active Comparator

Placebo Comparator

Arm Label

iHIVARNA-01

TriMix

Placebo

Arm Description

Biological: 1200μg mRNA (900 μg HIV mRNA+300 μg TriMix mRNA) 3 vaccinations, two weeks interval

Biological: TriMix_300 μg TriMix mRNA 3 vaccinations, two weeks interval

Water for injection 3 vaccinations, two weeks interval

Outcomes

Primary Outcome Measures

Number of Participants With Treatment-related Adverse Events as Assessed by CTCAE v4.0
Grade 3 or above local adverse event (pain, cutaneous reactions including induration). Grade 3 or above systemic adverse event (temperature, chills, headache, nausea, vomiting, malaise, and myalgia). Grade 3 or above other clinical or laboratory adverse event confirmed at examination or on repeat testing respectively. Any event attributable to vaccination leading to discontinuation of the immunisation regimen.
Immunogenicity as Measured by Elispot
Change from baseline immunogenicity as measured by ELISPOT at week 6 and 18, i.e. two weeks and 14 weeks after the last immunization compared to both control groups

Secondary Outcome Measures

Immunogenicity as Measured by Intracellular Cytokine Staining (ICS)
HIV-specific CD4+ and CD8+ T cell responses after immunization by the number of poly-functional T cells as determined by intracellular cytokine staining, (ICS).
Time to Viral Rebound
time until viral rebound (defined as two consecutive measurements of plasma viral load > 1000 copies/mL separated by at least 15 days) after discontinuation at week 6.
Change in Plasma Viral Load
difference in log10 copies/ml plasma viral load in vivo after analytical treatment interruption (ATI, week 6-restart ART), compared to placebo WFI
Functional Cure
proportion of patients with viral load below detectable level of 50 copies/mL in plasma after ATI, week 18
Primary Immune Response Against Vaccine
Change in frequency of at least 0.7log10 HIV-specific T-cell responses between baseline and week 6
CD8 T Cell Mediated Viral Suppression
The capacity of CD8 T cells to suppress virus production in HIV infected autologous CD4 T cells, after vaccination. For this purpose PBMC are isolated and separated in CD8 and CD4 T cells. CD4 cells are infected with HIV. Thereafter CD4 cells are co-cultured with pre-stimulated CD8 cells and the capacity to suppress virus production at different effector to target (E:T) ratios is measured, by the change of p24 Gag production. Pannus et al AIDS 2019, PMID: 30702513
Proviral DNA Reservoir
effect on reservoir as measured by changes in the proviral DNA copy numbers per million cells during and after immunization
Viral Immune Escape
viral immune escape: change in % mutated epitopes from pre-cART to post-ATI
Transcriptomics
host protein mRNA expression profiles in whole blood
Cell-associated RNA Viral Reservoir
effect on reservoir as measured by changes in the intracellular viral RNA copy numbers per million cells during and after immunization

Full Information

First Posted
August 23, 2016
Last Updated
December 11, 2019
Sponsor
Rob Gruters
Collaborators
Institut d'Investigacions Biomèdiques August Pi i Sunyer, IrsiCaixa, Institute of Tropical Medicine, Belgium, Vrije Universiteit Brussel, Synapse bv, Asphalion, eTheRNA immunotherapies, CR2O, Hospital Clinic of Barcelona, Germans Trias i Pujol Hospital, Universitair Ziekenhuis Brussel
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1. Study Identification

Unique Protocol Identification Number
NCT02888756
Brief Title
iHIVARNA Clinical Trial in HIV Infected Individuals
Acronym
iHIVARNA-01
Official Title
A Phase IIa Randomized, Placebo Controlled, Double Blinded Study to Evaluate the Safety and Immunogenicity of iHIVARNA-01 in Chronically HIV-infected Patients Under Stable Combined Antiretroviral Therapy
Study Type
Interventional

2. Study Status

Record Verification Date
December 2019
Overall Recruitment Status
Terminated
Why Stopped
Interim analysis did not show sufficient immunogenicity of IMP compared to placebo
Study Start Date
April 4, 2017 (Actual)
Primary Completion Date
February 12, 2018 (Actual)
Study Completion Date
February 12, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Rob Gruters
Collaborators
Institut d'Investigacions Biomèdiques August Pi i Sunyer, IrsiCaixa, Institute of Tropical Medicine, Belgium, Vrije Universiteit Brussel, Synapse bv, Asphalion, eTheRNA immunotherapies, CR2O, Hospital Clinic of Barcelona, Germans Trias i Pujol Hospital, Universitair Ziekenhuis Brussel

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
iHIVARNA-01 is a novel therapeutic vaccine for the treatment of HIV-1-infected patients based on in vivo modification of DCs. It consists of HIVACAT-TriMix: mRNA encoding a mixture of APC activation molecules (CD40L, a constitutively active variant of TLR4 and CD70) and the HIV target antigens contained in HIVACAT to be administered through the intranodal route. iHIVARNA-01 aims to achieve the 'functional cure' of HIV infection, i.e. controlling viral replication in the absence of anti-retroviral therapy.
Detailed Description
Objective: To evaluate the safety and immunogenicity of iHIVARNA-01 as a new therapeutic vaccine in HIV infected patients. Study design and duration: Phase IIa, multicentre double-blind placebo controlled intervention study. Each patient will be followed for 30 weeks. The study duration will be 38 weeks from inclusion of the first patient. Sites: Erasmus MC, Rotterdam The Netherlands (sponsor), Hospital Clínic de Barcelona and Institut de Recerca de la Sida - Caixa, Barcelona, Spain, Instituut voor Tropische Geneeskunde Antwerp, Belgium and Vrije Universiteit Brussel/UZ Brussel, Belgium Study population: Chronically HIV-1- infected patients under stable cART with plasma viral load (pVL) ≤ 50 copies/ml and stable CD4+ T-cell counts ≥ 450/μl, aged 18 years or above. Sample size: after recruitment and screening, 70 patients will be included and randomized to one of the study-arms. Intervention: One group (n=40) receives the HIVACAT-TriMix (300 microgram TriMix + 900 microgram HIVACAT) vaccine intranodally on three occasions with a two-week interval. One control group (n=15) receives TriMix only (300 microgram TriMix) and one group (n=15) receives saline intranodally on three occasions with a two-week interval. Two weeks after the last vaccination cART treatment will be interrupted. If plasma virus is detectable, cART will be re-initiated twelve weeks after treatment interruption. cART can always be re-initiated for medical reasons, as judged by the clinical investigator.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HIV Infections
Keywords
Immunotherapy, mRNA, Lentivirus infection, Virus disease, Sexually transmitted disease, Immunodeficiency syndrome

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
33 (Actual)

8. Arms, Groups, and Interventions

Arm Title
iHIVARNA-01
Arm Type
Experimental
Arm Description
Biological: 1200μg mRNA (900 μg HIV mRNA+300 μg TriMix mRNA) 3 vaccinations, two weeks interval
Arm Title
TriMix
Arm Type
Active Comparator
Arm Description
Biological: TriMix_300 μg TriMix mRNA 3 vaccinations, two weeks interval
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Water for injection 3 vaccinations, two weeks interval
Intervention Type
Biological
Intervention Name(s)
iHIVARNA-01
Other Intervention Name(s)
HIVACAT, TriMix
Intervention Description
Therapeutic vaccination, followed by treatment interruption
Intervention Type
Biological
Intervention Name(s)
TriMix
Intervention Description
Therapeutic vaccination, followed by treatment interruption
Intervention Type
Biological
Intervention Name(s)
Placebo
Intervention Description
Therapeutic vaccination, followed by treatment interruption
Primary Outcome Measure Information:
Title
Number of Participants With Treatment-related Adverse Events as Assessed by CTCAE v4.0
Description
Grade 3 or above local adverse event (pain, cutaneous reactions including induration). Grade 3 or above systemic adverse event (temperature, chills, headache, nausea, vomiting, malaise, and myalgia). Grade 3 or above other clinical or laboratory adverse event confirmed at examination or on repeat testing respectively. Any event attributable to vaccination leading to discontinuation of the immunisation regimen.
Time Frame
week 6
Title
Immunogenicity as Measured by Elispot
Description
Change from baseline immunogenicity as measured by ELISPOT at week 6 and 18, i.e. two weeks and 14 weeks after the last immunization compared to both control groups
Time Frame
week 6 and week 18
Secondary Outcome Measure Information:
Title
Immunogenicity as Measured by Intracellular Cytokine Staining (ICS)
Description
HIV-specific CD4+ and CD8+ T cell responses after immunization by the number of poly-functional T cells as determined by intracellular cytokine staining, (ICS).
Time Frame
week 10, 18 and 30
Title
Time to Viral Rebound
Description
time until viral rebound (defined as two consecutive measurements of plasma viral load > 1000 copies/mL separated by at least 15 days) after discontinuation at week 6.
Time Frame
week 6-18
Title
Change in Plasma Viral Load
Description
difference in log10 copies/ml plasma viral load in vivo after analytical treatment interruption (ATI, week 6-restart ART), compared to placebo WFI
Time Frame
week 6-18
Title
Functional Cure
Description
proportion of patients with viral load below detectable level of 50 copies/mL in plasma after ATI, week 18
Time Frame
week 18
Title
Primary Immune Response Against Vaccine
Description
Change in frequency of at least 0.7log10 HIV-specific T-cell responses between baseline and week 6
Time Frame
from baseline to week 6
Title
CD8 T Cell Mediated Viral Suppression
Description
The capacity of CD8 T cells to suppress virus production in HIV infected autologous CD4 T cells, after vaccination. For this purpose PBMC are isolated and separated in CD8 and CD4 T cells. CD4 cells are infected with HIV. Thereafter CD4 cells are co-cultured with pre-stimulated CD8 cells and the capacity to suppress virus production at different effector to target (E:T) ratios is measured, by the change of p24 Gag production. Pannus et al AIDS 2019, PMID: 30702513
Time Frame
week 4
Title
Proviral DNA Reservoir
Description
effect on reservoir as measured by changes in the proviral DNA copy numbers per million cells during and after immunization
Time Frame
day 0-90 (week 4, week 4 + 1 day and week 5 and week 6) and day 90-130 (week 18) and day >130 (week 30)
Title
Viral Immune Escape
Description
viral immune escape: change in % mutated epitopes from pre-cART to post-ATI
Time Frame
week 18
Title
Transcriptomics
Description
host protein mRNA expression profiles in whole blood
Time Frame
week 6 and 18
Title
Cell-associated RNA Viral Reservoir
Description
effect on reservoir as measured by changes in the intracellular viral RNA copy numbers per million cells during and after immunization
Time Frame
day 0-30 (week 4, week 4 + 1 day and week 5) and day 30-80 (week 6), 80-150 days (week 18) and >150 days (week 30)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: ≥ 18 years of age; Voluntarily signed informed consent; Proven HIV-1 infection (with documented antibodies against HIV-1 and a detectable plasma HIV-1 RNA before initiation of therapy); On stable treatment with cART regimen (antiretroviral therapy consisting of at least three registered antiretroviral agents) for at least 3 years; Nadir CD4+ ≥ 350 cells/μl (up to 2 occasional determinations ≤ 350 cells/μl are allowed); Current CD4+ cell count ≥ 450 cells/μl; HIV-RNA below 50 copies/mL in the last 6 months prior to randomization, during at least two measurements (occasional so called 'blips' ≤ 500 copies/mL are permitted); If sexually active, willing to use a reliable method of reducing the risk of transmission to their sexual partners during treatment interruption (including PrEP). For heterosexually active female, using an effective method of contraception with partner (combined oral contraceptive pill; injectable or implanted contraceptive; IUD/IUS; consistent record with condoms; physiological or anatomical sterility (in self or partner) from 14 days prior to the first vaccination until 4 months after the last vaccination. For heterosexually active male, using an effective method of contraception with their partner from the first day of vaccination until 4 months after the last vaccination. - Exclusion Criteria: Treatment with non-cART regimen prior to cART regimen; Previous failure to antiretroviral and/or mutations conferring genotypic resistance to antiretroviral therapy; Non-subtype B HIV infection; Active Hepatitis B virus and/or Hepatitis C virus co-infection; History of a CDC class C event (see appendix A); Pregnant female (screened with a positive pregnancy test), lactating or intending to become pregnant during the study; Active malignancy ≤ 30 days (extended period on the clinical assessment of the investigator) prior to screening; Active infection with fever (38°C or above) ≤ 10 days of screening and/or first vaccination; Therapy with immunomodulatory agents (e.g. systemic corticosteroids), including cytokines (e.g. IL-2), immunoglobulins and/or cytostatic chemotherapy ≤ 90 days prior to screening. This does not include seasonal influenza, hepatitis B and/or other travel related vaccines; Congenital, acquired or induced coagulation disorders, such as thrombocytopenia (thrombocytes < 150x109/L) and/or current use of anti-coagulant medication (e.g. coumarins, inhibitors of Xa); Usage of NSAIDs (including acetylsalicylic acid) is allowed, however it is advised to interrupt therapy 10 days ahead of vaccination; Usage of any investigational drug ≤ 90 days prior to study entry; An employee of the investigator or study site, with direct involvement in the proposed study or other studies under the direction of that investigator or study site, or is a family member of an employee or the investigator Any other condition, which, in the opinion of the investigator, may interfere with the evaluation of the study objectives
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Rob A Gruters, PhD
Organizational Affiliation
Erasmus Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Institute for Tropical Medicine
City
Antwerp
Country
Belgium
Facility Name
UZ Brussel
City
Brussels
Country
Belgium
Facility Name
Erasmus MC
City
Rotterdam
Country
Netherlands
Facility Name
Hospital Universitari Germans Trias i Pujol
City
Badalona
Country
Spain
Facility Name
Hospital Clinic
City
Barcelona
Country
Spain

12. IPD Sharing Statement

Citations:
PubMed Identifier
31208472
Citation
de Jong W, Aerts J, Allard S, Brander C, Buyze J, Florence E, van Gorp E, Vanham G, Leal L, Mothe B, Thielemans K, Plana M, Garcia F, Gruters R; iHIVARNA consortium. iHIVARNA phase IIa, a randomized, placebo-controlled, double-blinded trial to evaluate the safety and immunogenicity of iHIVARNA-01 in chronically HIV-infected patients under stable combined antiretroviral therapy. Trials. 2019 Jun 17;20(1):361. doi: 10.1186/s13063-019-3409-1. Erratum In: Trials. 2019 Dec 13;20(1):721.
Results Reference
derived
Links:
URL
https://clinicaltrials.gov/ct2/show/NCT02413645
Description
Description phase 1 clinical trial with iHIVARNA-01

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iHIVARNA Clinical Trial in HIV Infected Individuals

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