Title

Impact of a Human Papilloma Virus (HPV) Vaccine in HIV-Infected Young Women
Immunogenicity, Safety, Tolerability, and Behavioral Consequences of an HPV-6, -11, -16, -18 Vaccine in HIV-Infected Young Women
  • Phase

    Phase 2
  • Study Type

    Interventional
  • Intervention/Treatment

    hpv 16/18 vaccine ...
  • Study Participants

    99
The purpose of this study is to evaluate the immunogenicity, safety, tolerability, and behavioral impact of an HPV-6, -11, -16, -18 vaccine in HIV-infected young women.
Study Started
Feb 29
2008
Primary Completion
Feb 28
2011
Study Completion
Feb 28
2011
Results Posted
May 22
2017
Last Update
Jul 02
2017

Biological HPV vaccine for strains -6, -11, -16, and -18

All subjects will receive three doses of the HPV-6, -11, -16, -18 vaccine at the recommended dose and schedule (Day 0, Week 8, and Week 24).

A: HAART naive or no HAART in past 6 months Active Comparator

Participants who are ART naïve or, if ART-exposed, have not received highly active antiretroviral therapy (HAART) for at least the six months prior to study entry. All subjects will receive three doses of the HPV-6, -11, -16, -18 vaccine at the recommended dose and schedule (Day 0, Week 8, and Week 24).

B: HAART atleast 6 months/ 2 viral loads <400 in last 6 months Active Comparator

Participants who have been receiving highly active antiretroviral therapy (HAART) for at least six months at the time of study entry, with two HIV-1 RNA plasma viral loads < 400 copies/ml on two previous clinical visits within the 6 months prior to study entry. All subjects will receive three doses of the HPV-6, -11, -16, -18 vaccine at the recommended dose and schedule (Day 0, Week 8, and Week 24).

Criteria

Inclusion Criteria:

Young women age 16 years and 0 days to 23 years and 364 days
HIV-infection after the age of 9 years as documented by a positive result on any of the following licensed tests: any antibody test confirmed by Western blot, HIV-1 culture, HIV-1 DNA polymerase chain reaction (PCR), or plasma HIV-1 RNA > 1,000 copies/ml
HIV treatment history that falls in one of the following categories:

Group A: ART naïve or if ART-exposed, has not received HAART for at least the six months prior to study entry Group B: Has been receiving HAART for at least six months at the time of study entry, with two HIV-1 RNA plasma viral loads < 400 copies/ml on two previous clinical visits within the 6 months prior to study entry

Willingness to avoid pregnancy from study entry through the Week 28 visit for subjects of child-bearing potential, i.e., use of at least one barrier or hormonal method; e.g., condoms, Depo-Provera, oral contraceptive pills, etc. Subjects on antiretroviral (ARV) medications must use a barrier contraceptive method because ARV medications can make hormonal birth control less effective.
Anticipated ability and willingness to complete all study vaccines and evaluations
Ability and willingness to participate in the study by providing written informed consent

Exclusion Criteria:

History of any prior vaccination with an HPV vaccine
Active anogenital warts within three months prior to study entry) or history of cervical intraepithelial neoplasia (CIN) 2/3 (ever, must be documented by colposcopy)
Previous allergic reaction to any constituents of the HPV vaccine
Pregnancy
Active substance use or dependence that, in the opinion of the site personnel, would interfere with adherence to the study
Active opportunistic infection or current treatment for known or suspected active serious bacterial infection at the time of study entry
Presence of any known > Grade 3 clinical or laboratory toxicity at the time of study entry (per the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) Toxicity Tables, see ATN MOGO) with the exception of isolated Grade 3 serum total hyperbilirubinemia that is considered due to atazanavir (see Section 9.6 for definition of isolated total hyperbilirubinemia).
Receipt of any routine vaccine within four weeks prior to study entry
Receipt of any immune globulin or plasma product within six months prior study entry
Receipt of any blood product or transfusion, other than immune globulin or plasma as noted above, within four weeks prior to study entry
Receipt of any restricted medication listed in Section 5.3.2 within the four weeks preceding study entry
Receipt of any other disallowed medication listed in Section 5.3.3 within the three months preceding study entry
Thrombocytopenia or coagulation disorder that would contraindicate intramuscular injection
Anticipation of long-term systemic corticosteroid therapy (more than 10 mg/day of prednisone or equivalent for > 2 consecutive weeks)
Receipt of corticosteroid therapy at the above dose and duration within 3 months preceding study entry. Use of non-steroidal anti-inflammatory agents and inhaled or topical corticosteroids are not exclusion criteria
Known or suspected disease of the immune system (other than HIV), i.e., malignancy, current or prior treatment for malignancy
If other serious, acute or chronic medical or surgical conditions or contraindications are present during screening, the Protocol Team must be consulted to determine whether enrollment may interfere with the evaluation of the protocol objectives and for permission to proceed with the enrollment

Summary

Group A: HAART naïve or, if HAART Exposed, Has Not Received HA

Group B: Has Been Receiving HAART for > 6 Months, With Two HIV

All Events

Event Type Organ System Event Term Group A: HAART naïve or, if HAART Exposed, Has Not Received HA Group B: Has Been Receiving HAART for > 6 Months, With Two HIV

HPV-6 Antibody Level (Geometric Mean Titer of HPV-6)

The outcome measure for the primary objective is immunogenicity as measured by the GMT of HPV-6, -11, -16, -18 vaccine four weeks after the administration of vaccine dose #3, measured as a continuous variable. Vaccine dose # 3 was administered at Week 24.

All Study Participants Compared w/ Historical Comparison Group

738.9
Milli-Merck units/milliliter (mMU/mL) (Geometric Mean)
Standard Deviation: 908.7

HPV-11 Antibody Level (Geometric Mean Titer of HPV-11)

The outcome measure for the primary objective is immunogenicity as measured by the GMTs of HPV-6, -11, -16, -18 vaccine four weeks after the administration of vaccine dose #3, measured as a continuous variable. Vaccine Dose #3 was administered at Week 24.

All Study Participants Compared w/ Historical Comparison Group

896.0
mMU/mL (Geometric Mean)
Standard Deviation: 1132.1

HPV-16 Antibody Level (Geometric Mean Titer of HPV-16)

The outcome measure for the primary objective is immunogenicity as measured by the GMTs of HPV-6, -11, -16, -18 vaccine four weeks after the administration of vaccine dose #3, measured as a continuous variable. Vaccine dose # 3 was administered at Week 24.

All Study Participants Compared w/ Historical Comparison Group

2961.1
mMU/mL (Geometric Mean)
Standard Deviation: 3376.8

HPV-18 Antibody Level (Geometric Mean Titer of HPV-18)

The outcome measure for the primary objective is immunogenicity as measured by the GMTs of HPV-6, -11, -16, -18 vaccine four weeks after the administration of vaccine dose #3, measured as a continuous variable. Vaccine dose #3 was administered at Week 24.

All Study Participants Compared w/ Historical Comparison Group

576.5
mMU/mL (Geometric Mean)
Standard Deviation: 839.6

Immunogenicity of the HPV-6, -11, -16, -18 Vaccine Four Weeks After Vaccine Dose #3 as Measured as a Binary Variable (Responder vs. Non-responder) for HPV-18

Subjects who had a >= 24 mMU/mL were classified as responders; subjects who had a less than < 24 mMU/mL response were classified as non-responders.

All Study Participants Compared w/ Historical Comparison Group

Non-Responders

5.0
participants

Responders

62.0
participants

Number of Participants With At Least One Adverse Event Possibly, Probably, or Definitely Related to Vaccine

When a subject had at least one adverse event or sign/symptom during the study after doses 1, 2 or 3, and the event was possibly, probably, or definitely related to vaccine, this subject was considered to have had a vaccine-associated adverse event, sign and/or symptom.

All Study Participants

Group A

34.0
participants

Group B

14.0
participants

Persistence of Immunogenicity of the HPV-6, -11, -16, and -18 Vaccine 24 Weeks Post Vaccine Dose #3 as Measured by the Geometric Mean Titers (GMT) of HPV-6.

Persistence of immunogenicity as measured by geometric mean titers (GMT) to HPV-6, -11, -16, -18 vaccine 24 weeks after the administration of vaccine dose #3, measured as a continuous variable. Vaccine dose #3 was administered at Week 24.

All Study Participants

311.9
Milli-Merck units/milliliter (mMU/mL) (Geometric Mean)
Standard Deviation: 346.2

Persistence of Immunogenicity of the HPV-6, -11, -16, and -18 Vaccine 24 Weeks Post Vaccine Dose #3 as Measured by the Geometric Mean Titers (GMT) of HPV-11.

Persistence of immunogenicity as measured by geometric mean titers (GMT) to HPV-6, -11, -16, -18 vaccine 24 weeks after the administration of vaccine dose #3, measured as a continuous variable. Vaccine dose # 3 was administered at Week 24

All Study Participants

311.8
Milli-Merck units/milliliter (mMU/mL) (Geometric Mean)
Standard Deviation: 448.7

Persistence of Immunogenicity of the HPV-6, -11, -16, and -18 Vaccine 24 Weeks Post Vaccine Dose #3 as Measured by the Geometric Mean Titers (GMT) of HPV-16.

Persistence of immunogenicity as measured by geometric mean titers (GMT) to HPV-6, -11, -16, -18 vaccine 24 weeks after the administration of vaccine dose #3, measured as a continuous variable. Vaccine dose # 3 was administered at Week 24

All Study Participants

992.5
mMU/mL (Geometric Mean)
Standard Deviation: 1471.0

Persistence of Immunogenicity of the HPV-6, -11, -16, and -18 Vaccine 24 Weeks Post Vaccine Dose #3 as Measured by the Geometric Mean Titers (GMT) of HPV-18.

Persistence of immunogenicity as measured by geometric mean titers (GMT) to HPV-6, -11, -16, -18 vaccine 24 weeks after the administration of vaccine dose #3, measured as a continuous variable. Vaccine dose # 3 was administered at Week 24

All Study Participants

175.3
mMU/mL (Geometric Mean)
Standard Deviation: 324.8

Need for Safer Sexual Behaviors (NSSB) (Evaluated by Using the "12-item Knowledge About HPV and HPV Vaccine" Measure)

To characterize young women's risk perceptions, sexual behaviors, and sexually transmitted infections (STI) diagnoses over the 48 weeks after initial vaccination, the relationship of baseline "12-item Knowledge About HPV and HPV Vaccine" measure was used to evaluate the need for safer sexual behaviors.

Lower NSSB

47.5
percentage of participants

Higher NSSB

52.5
percentage of participants

Visit Compliance Via the Telephone Response System (TRS) Versus the Vaccine Report Card.

Visit compliance is the total number of days participants actually called the TRS or completed the VRC divided by the total number of days expected to call the TRS or complete the VRC, multiplied by 100%.

Telephone Response System (TRS)

51.3
percentage of days (Mean)
Standard Deviation: 27.4

Vaccine Report Card (VRC)

96.1
percentage of days (Mean)
Standard Deviation: 14.0

Adverse Events (AE) Reported Among Participants Who Were Randomized to the Telephone Response System (TRS) or Vaccine Report Card (VRC).

Rate of AEs is the total number of AEs divided by the total number of participants. The rate is not a percentage bur rather it could be above 1 or less than 1. This outcome measure looked at number of AEs reported, by grade; number of AEs > Grade 3 identified; and number of AEs > Grade 3 evaluated within 24 or 48 hours.

Telephone Response System (TRS)

Grade 1

0.93
AEs/Total Number of Participants

Grade 2

1.19
AEs/Total Number of Participants

Grade 3

0.07
AEs/Total Number of Participants

Grade 3 or above identified after evaluation

0.07
AEs/Total Number of Participants

Grade 4

Overall

2.19
AEs/Total Number of Participants

Vaccine Report Card (VRC)

Grade 1

1.37
AEs/Total Number of Participants

Grade 2

1.37
AEs/Total Number of Participants

Grade 3

0.08
AEs/Total Number of Participants

Grade 3 or above identified after evaluation

0.11
AEs/Total Number of Participants

Grade 4

0.03
AEs/Total Number of Participants

Overall

2.84
AEs/Total Number of Participants

Acquisition of HPV-6 DNA by Study Group and Study Visit (Week 24).

Type-specific HPV DNA among subjects who were both HPV DNA negative and HPV-6 sero-negative by study group and study visit at Week 24.

Group A

No

92.3
percentage of participants

Yes

7.7
percentage of participants

Group B

No

91.7
percentage of participants

Yes

8.3
percentage of participants

Acquisition of HPV-11 DNA by Study Group and Study Visit (Week 24).

Type-specific HPV DNA among subjects who were both HPV DNA negative and HPV-11 sero-negative by study group and study visit at Week 24.

Group A

No

97.7
percentage of participants

Yes

2.3
percentage of participants

Group B

No

100.0
percentage of participants

Yes

Acquisition of HPV-16 DNA by Study Group and Study Visit (Week 24).

Type-specific HPV DNA among subjects who were both HPV DNA negative and HPV-16 sero-negative by study group and study visit at Week 24.

Group A

No

97.2
percentage of participants

Yes

2.8
percentage of participants

Group B

No

100.0
percentage of participants

Yes

Acquisition of HPV-18 DNA by Study Group and Study Visit (Week 24).

Type-specific HPV DNA among subjects who were both HPV DNA negative and HPV-18 sero-negative by study group and study visit at Week 24.

Group A

No

95.9
percentage of participants

Yes

4.1
percentage of participants

Group B

No

94.4
percentage of participants

Yes

5.6
percentage of participants

Acquisition of HPV-6 DNA by Study Group and Study Visit (Week 48).

Type-specific HPV DNA among subjects who were both HPV DNA negative and HPV sero-negative by study group and study visit at Week 48.

Group A

No

91.7
percentage of participants

Yes

8.3
percentage of participants

Group B

No

91.7
percentage of participants

Yes

8.3
percentage of participants

Acquisition of HPV-11 DNA by Study Group and Study Visit (Week 48).

Type-specific HPV DNA among subjects who were both HPV DNA negative and HPV sero-negative by study group and study visit at Week 48.

Group A

No

94.9
percentage of participants

Yes

5.1
percentage of participants

Group B

No

100.0
percentage of participants

Yes

Acquisition of HPV-16 DNA by Study Group and Study Visit (Week 48).

Type-specific HPV DNA among subjects who were both HPV DNA negative and HPV sero-negative by study group and study visit at Week 48.

Group A

No

94.1
percentage of participants

Yes

5.9
percentage of participants

Group B

No

92.9
percentage of participants

Yes

7.1
percentage of participants

Acquisition of HPV-18 DNA by Study Group and Study Visit (Week 48).

Type-specific HPV DNA among subjects who were both HPV DNA negative and HPV sero-negative by study group and study visit at Week 48.

Group A

No

91.3
percentage of participants

Yes

8.7
percentage of participants

Group B

No

93.8
percentage of participants

Yes

6.3
percentage of participants

Percentage of Participants Who Reported a Lower Need to Practice Safe Sex Following HPV Vaccination and the Percentage of Participants That Reported a Higher Need to Practice Safe Sex Following HPV Vaccination

Participants' perceptions for the need to practice safe sex following HPV vaccination was measured using a safer sexual behaviors subscale, which was comprised of the following five questions: After getting vaccinated against HPV … You feel that condom use during sex is less necessary. You feel it is still just as important to have as few sexual partners as possible. You feel that it is less important to talk to your sex partners about safe sex. You think it is still just as important to use a condom every time you have sex. You will be less worried about having unprotected sex. Those who were categorized in the "lower need for safer sexual behaviors (NSSB)" group had a summary score that was less than the median and those in the "higher NSSB" group had a summary score that was equal to or higher than the median.

Lower NSSB

47.5
percentage of participants

Higher NSSB

52.5
percentage of participants

Immunogenicity of the HPV-6, -11, -16, -18 Vaccine Four Weeks After Vaccine Dose #3 as Measured as a Binary Variable (Responder vs. Non-responder) for HPV-6

Subjects who had a greater than or equal to (>=) 20 Milli-Merck units (mMU)/milliliter (mL) response were classified as responders; subjects who had a less than (<) 20 mMU/mL response were classified as non-responders.

All Study Participants Compared w/ Historical Comparison Group

Non-Responder

1.0
participants

Responder

39.0
participants

Immunogenicity of the HPV-6, -11, -16, -18 Vaccine Four Weeks After Vaccine Dose #3 as Measured as a Binary Variable (Responder vs. Non-responder) for HPV-11

Subjects who had a >= 16 mMU/mL were classified as responders; subjects who had a less than < 16 mMU/mL response were classified as non-responders.

All Study Participants Compared w/ Historical Comparison Group

Non-Responders

2.0
participants

Responders

61.0
participants

Immunogenicity of the HPV-6, -11, -16, -18 Vaccine Four Weeks After Vaccine Dose #3 as Measured as a Binary Variable (Responder vs. Non-responder) for HPV-16

Subjects who had a >= 20 mMU/mL were classified as responders; subjects who had a less than < 20 mMU/mL response were classified as non-responders.

All Study Participants Compared w/ Historical Comparison Group

Non-Responders

2.0
participants

Responders

49.0
participants

Total

99
Participants

Age, Customized

Region of Enrollment

Sex: Female, Male

Overall Study

ART/HAART NAIVE

HAART

Drop/Withdrawal Reasons

ART/HAART NAIVE

HAART