Patient case (clinical description): A 30-year-old man who is a computer scientist came to the clinic with the lab result stating azoospermia.  The patient is sexually active with his wife and does not use any contraception methods.  They have been trying to conceive for the past year with no success.  The patient has a past medical history of recurrent pneumonia, shortness of breath, and  persistent cough that produces large amounts of thick sputum. The patient had multiple lung infections during childhood. He does not smoke, use illicit drugs or alcohol.  The patient has no history of other medical conditions including allergies or any kind of surgery.  On physical examination, the digits show clubbing.  An ultrasound shows bilateral absence of the vas deferens, and FEV1 was 75% on the respiratory function test.

Patient's own account: I'm a 30-year-old computer scientist. I did some lab tests that came back quite alarming, stating that I have azoospermia?! I'm sexually active with my wife and we don't use contraception. We've been trying to have a child for the past year. I have a medical history of pneumonia and shortness of breath and regular wet cough. I had several lung infections when I was a kid. That's why I'm very careful and don't smoke, do drugs, or drink. I don't have other medical conditions including allergies or any kind of surgery. The doctor did the clubbing test on my fingers, which was positive. I also did an ultrasound and it showed that I'm missing the tubes that carry sperm around. I also had a 75% for my respiratory function test.

Clinical trial: Evaluating the Safety and Immunogenicity of HIV Clade C DNA Vaccine and MF59- or AS01B-Adjuvanted Clade C Env Protein Vaccines in Various Combinations in Healthy, HIV-Uninfected Adults

Eligibility criteria:
Inclusion Criteria:

        General and Demographic Criteria

          -  Age of 18 to 40 years

          -  Access to a participating HVTN clinical research site (CRS) and willingness to be
             followed for the planned duration of the study

          -  Ability and willingness to provide informed consent

          -  Assessment of understanding: volunteer demonstrates understanding of this study;
             completes a questionnaire prior to first vaccination with verbal demonstration of
             understanding of all questionnaire items answered incorrectly

          -  Agrees not to enroll in another study of an investigational research agent before the
             last required protocol clinic visit

          -  Willing to be contacted by phone, text message, or e-mail 6 months after completion of
             the scheduled clinic visits

          -  Good general health as shown by medical history, physical exam, and screening
             laboratory tests

        HIV-Related Criteria:

          -  Willingness to receive HIV test results

          -  Willingness to discuss HIV infection risks and amenable to HIV risk reduction
             counseling.

          -  Assessed by the clinic staff as being at "low risk" for HIV infection and committed to
             maintaining behavior consistent with low risk of HIV exposure through the last
             required protocol clinic visit.

        Laboratory Inclusion Values:

        Hemogram/Complete Blood Count (CBC)

          -  Hemoglobin greater than or equal to 11.0 g/dL for volunteers who were born female,
             greater than or equal to 13.0 g/dL for volunteers who were born male

          -  White blood cell count equal to 3,300 to 12,000 cells/mm^3

          -  Total lymphocyte count greater than or equal to 800 cells/mm^3

          -  Remaining differential either within institutional normal range or with site physician
             approval

          -  Platelets equal to 125,000 to 550,000/mm^3

        Chemistry

          -  Chemistry panel: ALT, AST, and alkaline phosphatase less than 1.25 times the
             institutional upper limit of normal; creatinine less than or equal to institutional
             upper limit of normal.

        Virology

          -  Negative HIV-1 and -2 blood test: US volunteers must have a negative FDA-approved
             enzyme immunoassay (EIA). Non-US sites may use locally available assays that have been
             approved by HVTN Laboratory Operations.

          -  Negative Hepatitis B surface antigen (HBsAg)

          -  Negative anti-Hepatitis C virus antibodies (anti-HCV), or negative HCV polymerase
             chain reaction (PCR) if the anti-HCV is positive

        Urine

          -  Normal urine:

               -  Negative urine glucose, and

               -  Negative or trace urine protein, and

               -  Negative or trace urine hemoglobin (if trace hemoglobin is present on dipstick, a
                  microscopic urinalysis with red blood cells levels within institutional normal
                  range).

        Reproductive Status

          -  Volunteers who were born female: negative serum or urine beta human chorionic
             gonadotropin (β-HCG) pregnancy test performed prior to vaccination on the day of
             initial vaccination. Persons who are NOT of reproductive potential due to having
             undergone total hysterectomy or bilateral oophorectomy (verified by medical records),
             are not required to undergo pregnancy testing.

        Reproductive status:

        United States

        A volunteer who was born female must:

          -  Agree to consistently use effective contraception (see the protocol for more
             information) for sexual activity that could lead to pregnancy from at least 21 days
             prior to enrollment through the last required protocol clinic visit. Effective
             contraception for participants in the United States is defined as using any 1 or more
             of the following methods:

               -  Condoms (male or female) with or without a spermicide,

               -  Diaphragm or cervical cap with spermicide,

               -  Intrauterine device (IUD),

               -  Hormonal contraception, or

               -  Successful vasectomy in the male partner (considered successful if a volunteer
                  reports that a male partner has [1] documentation of azoospermia by microscopy,
                  or [2] a vasectomy more than 2 years ago with no resultant pregnancy despite
                  sexual activity postvasectomy), or

               -  Any other contraceptive method approved by the HVTN 108 protocol safety review
                  team (PSRT)

          -  Or not be of reproductive potential, such as having reached menopause (no menses for 1
             year) or having undergone hysterectomy, bilateral oophorectomy, or tubal ligation;

          -  Or be sexually abstinent.

        Southern Africa

        A volunteer who was born female must:

          -  Agree to consistently use effective contraception (see the protocol for more
             information) for sexual activity that could lead to pregnancy from at least 21 days
             prior to enrollment through the last required protocol clinic visit. Effective
             contraception for participants in Southern Africa is defined as using 2 methods of
             birth control. These include 1 of the following methods:

               -  Condoms (male or female)

               -  Diaphragm or cervical cap

          -  PLUS 1 of the following methods:

               -  IUD,

               -  Hormonal contraception (in accordance with applicable national contraception
                  guidelines), or

               -  Successful vasectomy in the male partner (considered successful if a volunteer
                  reports that a male partner has [1] documentation of azoospermia by microscopy,
                  or [2] a vasectomy more than 2 years ago with no resultant pregnancy despite
                  sexual activity postvasectomy), or

               -  Any other contraceptive method approved by the HVTN 108 PSRT

          -  Or not be of reproductive potential, such as having reached menopause (no menses for 1
             year) or having undergone hysterectomy, bilateral oophorectomy, or tubal ligation;

          -  Or be sexually abstinent.

          -  Volunteers who were born female must also agree not to seek pregnancy through
             alternative methods, such as artificial insemination or in vitro fertilization until
             after the last required protocol clinic visit

        Other

        Volunteers 21 years of age and older who were born female consenting to provide cervical
        samples:

          -  Pap smear within:

               -  the 3 years prior to enrollment with the latest result reported as normal or
                  atypical squamous cells of undetermined significance (ASCUS), or

               -  the 5 years prior to enrollment, with the latest result reported as normal, or
                  ASCUS with no evidence of high risk human papillomavirus (HPV).

          -  If no pap smear was done within the last 3 years (or within the last 5 years, if high
             risk HPV testing was performed), the volunteer must be willing to undergo a pap smear
             with the result reported as normal or ASCUS prior to sample collection.

        Exclusion Criteria:

        General

          -  Blood products received within 120 days before first vaccination

          -  Investigational research agents received within 30 days before first vaccination

          -  Body mass index (BMI) greater than or equal to 40; or BMI greater than or equal to 35
             with 2 or more of the following: systolic blood pressure greater than 140 mm Hg,
             diastolic blood pressure greater than 90 mm Hg, current smoker, known hyperlipidemia

          -  Intent to participate in another study of an investigational research agent or any
             other study that requires non-HVTN HIV antibody testing during the planned duration of
             the HVTN 108 study

          -  Pregnant or breastfeeding

          -  Active duty and reserve US military personnel

        Vaccines and Other Injections

          -  HIV vaccine(s) received in a prior HIV vaccine trial. For volunteers who have received
             control/placebo in an HIV vaccine trial, the HVTN 108 PSRT will determine eligibility
             on a case-by-case basis.

          -  Non-HIV experimental vaccine(s) received within the last 5 years in a prior vaccine
             trial. Exceptions may be made for vaccines that have subsequently undergone licensure.
             For volunteers who have received control/placebo in an experimental vaccine trial, the
             HVTN 108 PSRT will determine eligibility on a case-by-case basis. For volunteers who
             have received an experimental vaccine(s) greater than 5 years ago, eligibility for
             enrollment will be determined by the HVTN 108 PSRT on a case-by-case basis.

          -  Live attenuated vaccines other than influenza vaccine received within 30 days before
             first vaccination or scheduled within 14 days after injection (eg, measles, mumps, and
             rubella [MMR]; oral polio vaccine [OPV]; varicella; yellow fever)

          -  Influenza vaccine or any vaccines that are not live attenuated vaccines and were
             received within 14 days prior to first vaccination (eg, tetanus, pneumococcal,
             Hepatitis A or B)

          -  Allergy treatment with antigen injections within 30 days before first vaccination or
             that are scheduled within 14 days after first vaccination

        Immune System

          -  Immunosuppressive medications received within 168 days before first vaccination. (Not
             exclusionary: [1] corticosteroid nasal spray; [2] inhaled corticosteroids; [3] topical
             corticosteroids for mild, uncomplicated dermatitis; or [4] a single course of
             oral/parenteral corticosteroids at doses less than 2 mg/kg/day and length of therapy
             less than 11 days with completion at least 30 days prior to enrollment.)

          -  Serious adverse reactions to vaccines or to vaccine components including history of
             anaphylaxis and related symptoms such as hives, respiratory difficulty, angioedema,
             and/or abdominal pain. (Not excluded from participation: a volunteer who had a
             nonanaphylactic adverse reaction to pertussis vaccine as a child.)

          -  Immunoglobulin received within 60 days before first vaccination

          -  Autoimmune disease

          -  Immunodeficiency

        Clinically significant medical conditions

          -  Untreated or incompletely treated syphilis infection

          -  Clinically significant medical condition, physical examination findings, clinically
             significant abnormal laboratory results, or past medical history with clinically
             significant implications for current health. A clinically significant condition or
             process includes but is not limited to:

               -  A process that would affect the immune response,

               -  A process that would require medication that affects the immune response,

               -  Any contraindication to repeated injections or blood draws,

               -  A condition that requires active medical intervention or monitoring to avert
                  grave danger to the volunteer's health or well-being during the study period,

               -  A condition or process for which signs or symptoms could be confused with
                  reactions to vaccine, or

               -  Any condition specifically listed among the exclusion criteria below.

          -  Any medical, psychiatric, occupational, or other condition that, in the judgment of
             the investigator, would interfere with, or serve as a contraindication to, protocol
             adherence, assessment of safety or reactogenicity, or a volunteer's ability to give
             informed consent

          -  Psychiatric condition that precludes compliance with the protocol. Specifically
             excluded are persons with psychoses within the past 3 years, ongoing risk for suicide,
             or history of suicide attempt or gesture within the past 3 years.

          -  Current anti-tuberculosis (TB) prophylaxis or therapy

          -  Asthma other than mild, well-controlled asthma. (Symptoms of asthma severity as
             defined in the most recent US National Asthma Education and Prevention Program (NAEPP)
             Expert Panel report). Exclude a volunteer who:

               -  Uses a short-acting rescue inhaler (typically a beta 2 agonist) daily, or

               -  Uses moderate/high dose inhaled corticosteroids, or

               -  In the past year has either of the following:

               -  Greater than 1 exacerbation of symptoms treated with oral/parenteral
                  corticosteroids;

               -  Needed emergency care, urgent care, hospitalization, or intubation for asthma.

          -  Diabetes mellitus type 1 or type 2, including cases controlled with diet alone. (Not
             excluded: history of isolated gestational diabetes.)

          -  Thyroidectomy, or thyroid disease requiring medication during the last 12 months

          -  Hypertension:

               -  If a person has been found to have elevated blood pressure or hypertension during
                  screening or previously, exclude for blood pressure that is not well controlled.
                  Well-controlled blood pressure is defined as consistently less than or equal to
                  140 mm Hg systolic and less than or equal to 90 mm Hg diastolic, with or without
                  medication, with only isolated, brief instances of higher readings, which must be
                  less than or equal to 150 mm Hg systolic and less than or equal to 100 mm Hg
                  diastolic. For these volunteers, blood pressure must be less than or equal to 140
                  mm Hg systolic and less than or equal to 90 mm Hg diastolic at enrollment.

               -  If a person has NOT been found to have elevated blood pressure or hypertension
                  during screening or previously, exclude for systolic blood pressure greater than
                  or equal to 150 mm Hg at enrollment or diastolic blood pressure greater than or
                  equal to 100 mm Hg at enrollment.

          -  Bleeding disorder diagnosed by a doctor (eg, factor deficiency, coagulopathy, or
             platelet disorder requiring special precautions)

          -  Malignancy (Not excluded from participation: Volunteer who has had malignancy excised
             surgically and who, in the investigator's estimation, has a reasonable assurance of
             sustained cure, or who is unlikely to experience recurrence of malignancy during the
             period of the study)

          -  Seizure disorder: History of seizure(s) within past 3 years. Also exclude if volunteer
             has used medications in order to prevent or treat seizure(s) at any time within the
             past 3 years.

          -  Asplenia: any condition resulting in the absence of a functional spleen

          -  History of hereditary angioedema, acquired angioedema, or idiopathic angioedema.
No condition on gender to be admitted to the trial.
Accepts Healthy Volunteers
Subject must be at least 18 Years old.
Subject must be at most 40 Years

Eligibility (NLI label): Contradiction