Title

iHIVARNA Clinical Trial in HIV Infected Individuals
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
  • Phase

    Phase 2
  • Study Type

    Interventional
  • Study Participants

    33
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.
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.
Study Started
Apr 04
2017
Primary Completion
Feb 12
2018
Study Completion
Feb 12
2018
Results Posted
Dec 09
2019
Last Update
Dec 23
2019

Biological iHIVARNA-01

Therapeutic vaccination, followed by treatment interruption

  • Other names: HIVACAT, TriMix

Biological TriMix

Therapeutic vaccination, followed by treatment interruption

Biological Placebo

Therapeutic vaccination, followed by treatment interruption

iHIVARNA-01 Experimental

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

TriMix Active Comparator

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

Placebo Placebo Comparator

Water for injection 3 vaccinations, two weeks interval

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

Summary

iHIVARNA-01

TriMix

Placebo

All Events

Event Type Organ System Event Term iHIVARNA-01 TriMix Placebo

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.

iHIVARNA-01

TriMix

Placebo

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

iHIVARNA-01

week 18

-0.08
delta log difference spot forming units (Mean)
95% Confidence Interval: -0.57 to 0.42

week 6

-0.07
delta log difference spot forming units (Mean)
95% Confidence Interval: -0.35 to 0.2

TriMix

week 18

-0.12
delta log difference spot forming units (Mean)
95% Confidence Interval: -0.61 to 0.36

week 6

0.18
delta log difference spot forming units (Mean)
95% Confidence Interval: -0.17 to 0.52

Placebo

week 18

0.45
delta log difference spot forming units (Mean)
95% Confidence Interval: -0.52 to 1.42

week 6

0.01
delta log difference spot forming units (Mean)
95% Confidence Interval: -0.57 to 0.6

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).

iHIVARNA-01

TriMix

Placebo

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.

iHIVARNA-01

50.0
days (Median)
95% Confidence Interval: 33.0 to 57.0

TriMix

55.5
days (Median)
95% Confidence Interval: 43.0 to 77.0

Placebo

58.0
days (Median)
95% Confidence Interval: 36.0 to 72.0

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

iHIVARNA-01

-0.17
log10 copies/ml (Geometric Mean)
95% Confidence Interval: -1.1 to 0.77

TriMix

-0.14
log10 copies/ml (Geometric Mean)
95% Confidence Interval: -1.18 to 0.9

Placebo

1.26
log10 copies/ml (Geometric Mean)
95% Confidence Interval: 0.21 to 2.31

Functional Cure

proportion of patients with viral load below detectable level of 50 copies/mL in plasma after ATI, week 18

iHIVARNA-01

TriMix

Placebo

Primary Immune Response Against Vaccine

Change in frequency of at least 0.7log10 HIV-specific T-cell responses between baseline and week 6

iHIVARNA-01

0.01
delta log spot forming units (Mean)
95% Confidence Interval: -0.56 to 0.57

TriMix

0.17
delta log spot forming units (Mean)
95% Confidence Interval: -0.47 to 0.81

Placebo

2.65
delta log spot forming units (Mean)
95% Confidence Interval: 1.94 to 3.37

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

iHIVARNA-01

Stimulated (E:T) 0.1:1

-0.65
log(pg/ml) (Mean)
95% Confidence Interval: -1.26 to -0.05

stimulated (E:T) 2:1

0.15
log(pg/ml) (Mean)
95% Confidence Interval: -0.69 to 0.99

TriMix

Stimulated (E:T) 0.1:1

-1.32
log(pg/ml) (Mean)
95% Confidence Interval: -2.0 to -0.65

stimulated (E:T) 2:1

0.22
log(pg/ml) (Mean)
95% Confidence Interval: -0.73 to 1.16

Placebo

Stimulated (E:T) 0.1:1

0.41
log(pg/ml) (Mean)
95% Confidence Interval: -0.08 to 0.9

stimulated (E:T) 2:1

0.18
log(pg/ml) (Mean)
95% Confidence Interval: -0.48 to 0.85

Proviral DNA Reservoir

effect on reservoir as measured by changes in the proviral DNA copy numbers per million cells during and after immunization

iHIVARNA-01

proviral DNA 0-90 days

-0.002
delta log copies DNA /10E6 cel (Mean)
95% Confidence Interval: -0.007 to 0.003

proviral DNA >130 days

-0.001
delta log copies DNA /10E6 cel (Mean)
95% Confidence Interval: -0.007 to 0.005

proviral DNA 90-130 days

0.004
delta log copies DNA /10E6 cel (Mean)
95% Confidence Interval: -0.01 to 0.019

TriMix

proviral DNA 0-90 days

-0.001
delta log copies DNA /10E6 cel (Mean)
95% Confidence Interval: -0.007 to 0.004

proviral DNA >130 days

-0.002
delta log copies DNA /10E6 cel (Mean)
95% Confidence Interval: -0.01 to 0.006

proviral DNA 90-130 days

0.004
delta log copies DNA /10E6 cel (Mean)
95% Confidence Interval: -0.013 to 0.02

Placebo

proviral DNA 0-90 days

0.007
delta log copies DNA /10E6 cel (Mean)
95% Confidence Interval: 0.003 to 0.011

proviral DNA >130 days

-0.003
delta log copies DNA /10E6 cel (Mean)
95% Confidence Interval: -0.007 to 0.002

proviral DNA 90-130 days

-0.003
delta log copies DNA /10E6 cel (Mean)
95% Confidence Interval: -0.015 to 0.008

Viral Immune Escape

viral immune escape: change in % mutated epitopes from pre-cART to post-ATI

iHIVARNA-01

TriMix

Placebo

Transcriptomics

host protein mRNA expression profiles in whole blood

iHIVARNA-01

TriMix

Placebo

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

iHIVARNA-01

caRNA 0-30 days

-0.001
delta log copies RNA/ml (Mean)
95% Confidence Interval: -0.009 to 0.007

caRNA >150 days

0.002
delta log copies RNA/ml (Mean)
95% Confidence Interval: -0.008 to 0.011

caRNA 30-80 days

-0.006
delta log copies RNA/ml (Mean)
95% Confidence Interval: -0.015 to 0.003

caRNA 80-150 days

0.002
delta log copies RNA/ml (Mean)
95% Confidence Interval: -0.008 to 0.012

TriMix

caRNA 0-30 days

-0.002
delta log copies RNA/ml (Mean)
95% Confidence Interval: -0.012 to 0.008

caRNA >150 days

-0.001
delta log copies RNA/ml (Mean)
95% Confidence Interval: -0.012 to 0.01

caRNA 30-80 days

-0.001
delta log copies RNA/ml (Mean)
95% Confidence Interval: -0.014 to 0.01

caRNA 80-150 days

0.003
delta log copies RNA/ml (Mean)
95% Confidence Interval: -0.008 to 0.015

Placebo

caRNA 0-30 days

-0.004
delta log copies RNA/ml (Mean)
95% Confidence Interval: -0.011 to 0.003

caRNA >150 days

-0.004
delta log copies RNA/ml (Mean)
95% Confidence Interval: -0.011 to 0.003

caRNA 30-80 days

0.032
delta log copies RNA/ml (Mean)
95% Confidence Interval: 0.024 to 0.04

caRNA 80-150 days

-0.016
delta log copies RNA/ml (Mean)
95% Confidence Interval: -0.024 to -0.008

Total

33
Participants

CD4 T cell counts

769
cells/microliter (Median)
Inter-Quartile Range: 664.0 to 974.0

Race and Ethnicity Not Collected

0
Participants

Age, Categorical

Region of Enrollment

Sex: Female, Male

Vaccination Period

iHIVARNA-01

TriMix

Placebo

Analytical Treatment Interruption

iHIVARNA-01

TriMix

Placebo

Drop/Withdrawal Reasons

iHIVARNA-01

TriMix

Placebo