During the course of HIV infection the number of CD4 cells decreases, resulting in a reduced immunological response and ultimately immune deficiency. Vacc-4x is a peptide-based HIV immunotherapy and the primary objective is to strengthen the immune system's response to HIV p24. By adding Lenalidomide, an immunomodulatory agent, as a supporting drug, it is anticipated that the effect of Vacc-4x might be enhanced.
Human immunodeficiency virus (HIV) infects the CD4 subset of T-cells that are critical for initiating immune responses to infection. The level of CD4 cells in the blood is a marker of a patient's immunological status. The number of CD4 cells decreases in the course of the HIV infection and results in a reduced immunological response and eventually immune deficiency. Vacc-4x is one of the few peptide-based therapeutic vaccines tested, and consists of four, slightly modified HIV Gag p24 consensus peptides. Vacc-4x was first tested by intradermal injections using GM-CSF as adjuvant. A recent multinational placebo-controlled study found improvement of vaccine-specific T cell immunity and decrease in viral loads (presented at the AIDS vaccine 2011 conference, Bangkok). Lenalidomide (CC-5013) is a substance in the class of immunomodulatory agents. The lenalidomide mechanism of action includes anti-neoplastic, pro-erythropoietic, and immunomodulatory properties. Lenalidomide inhibits proliferation of certain hematopoietic tumor cells, enhances T cell- and Natural Killer (NK) cell-mediated immunity and increases the number of NK T cells. The anti-HIV p24 immune response resulting from Vacc-4x immunization could in combination with ART potentially improve immune reconstitution in patients who have not fully regained a healthy CD4 level (\> 600 x106/L). Adding the immunomodulatory agent Lenalidomide (CC-5013) to Vacc-4x immunization could enhance the immune response to Vacc-4x and further strengthen immune reconstitution.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
QUADRUPLE
Enrollment
36
In Part A a dose escalation design is used (2,5; 5; 10; 25 mg). Part B will use the dose confirmed by Part A
Capsules are identical to the active Lenalidomide capsules used.
Vacc-4x is a peptide-based HIV immunotherapy administered intradermally. Vacc-4x peptides are reconstituted in sterile water.
University Medical Center Hamburg-Eppendorf
Hamburg, Free and Hanseatic City of Hamburg, Germany
EIPMED - Gesellschaft fűr epidemiologische und klinische Forschung in der Medizin mbH Rubensstrasse 125
Berlin, State of Berlin, Germany
Charite Campus, Virchow-Klinikum Medizinische Klinik mit Schwerpunkt Infektiologie Station 59 (Suedring 11) Augustenburger Platz 1
Berlin, State of Berlin, Germany
Klinik I für Innere Medizin Klinikum Der Universität zu Köln
Cologne, Germany
Part A: To Establish Highest Tolerated Dose of Lenalidomide, Dose-Limiting Toxicity
Number of participants in each of the three groups that experienced any dose-limiting toxicity.
Time frame: 31 days
Part A: To Establish Highest Tolerated Dose of Lenalidomide, CD4 Counts Over Time
Time frame: 31 days
Part B: Change in CD4 Count
Change in CD4 count from baseline to Week 26.
Time frame: Week 26
Part B: Change in CD8 Count
Change in CD8 count from baseline to week 26.
Time frame: 26 weeks
Part B: Evaluate the Effect on HIV Viral Load
Results BLQ (\<20 HIV copies/mL) have been replaced with BLQ/2 = 10 HIV copies/mL while 'not detected' results have been replaced with 0 HIV copies/mL.
Time frame: 26 weeks
Part B: Incidents of Delayed-type Hypersensitivity
Delayed-type hypersensitivity measured by induration and erythema.
Time frame: 26 weeks
Part A and B: Safety and Tolerability
Time frame: Part A: 31 days and Part B: 26 weeks
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Granulocyte macrophage colony stimulating factor as a local adjuvant