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 Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
33
Therapeutic vaccination, followed by treatment interruption
Therapeutic vaccination, followed by treatment interruption
Therapeutic vaccination, followed by treatment interruption
Institute for Tropical Medicine
Antwerp, Belgium
UZ Brussel
Brussels, Belgium
Erasmus MC
Rotterdam, Netherlands
Hospital Universitari Germans Trias i Pujol
Badalona, Spain
Hospital Clinic
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.
Time frame: week 6
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
Time frame: week 6 and week 18
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 frame: week 10, 18 and 30
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.
Time frame: week 6-18
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
Time frame: week 6-18
Functional Cure
proportion of patients with viral load below detectable level of 50 copies/mL in plasma after ATI, week 18
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Barcelona, Spain
Time frame: 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
Time frame: from baseline to 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
Time frame: week 4
Proviral DNA Reservoir
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)
Viral Immune Escape
viral immune escape: change in % mutated epitopes from pre-cART to post-ATI
Time frame: week 18
Transcriptomics
host protein mRNA expression profiles in whole blood
Time frame: week 6 and 18
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
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)