"Prime-Boost" Vaccine Schedule for Prevention of HIV Infection
Condition: HIV Infections
MeSH terms: Infections; HIV Infections; Acquired Immunodeficiency Syndrome
Study type: Interventional
Phase: Phase 1

Summary: 
      This study will determine the safety and side effects of two experimental HIV vaccines given
      in a "prime-boost" schedule. It will also monitor participants for the social impact of being
      in an HIV vaccine study (e.g., problems with insurance, health care, friends, family,
      employment, housing, and so forth). The vaccines are VRC-HIVDNA016-00-VP (called the DNA
      vaccine) and VRC-HIVADV014-00-VP (called the rAd vaccine). The DNA vaccine codes for four HIV
      proteins. The rAd vaccine is made using an adenovirus (a common virus that causes upper
      respiratory infections, such as the common cold) that has been modified to contain DNA that
      codes for three HIV proteins. These vaccines cannot cause HIV or adenoviral infections.

      The study will also see if the vaccines cause an immune response; if the injection of the DNA
      vaccine given using a needle and syringe is similar in safety and immune response to giving
      them with a needleless injection device called a Biojector 2000; if people who already have
      antibodies to adenovirus still have an immune response to rAd vaccine; and if there are
      social harms that result from participating in an HIV vaccine study.

      Healthy volunteers between 18 and 50 years of age may be eligible for this 42-week study.
      Candidates are screened with a medical history, physical examination, blood and urine tests
      (including pregnancy test for women), and questions regarding sexual behavior and other
      practices.

      Participants receive three injections (shots) of the DNA vaccine and one injection of the rAd
      vaccine. All injections are given into a muscle in the upper arm (alternating right and left
      arms with each injection), using a needle and syringe or the needleless Biojector 2000. The
      first vaccination is given the day of enrollment into the study, and the DNA vaccinations are
      given about 4 weeks apart from each other, with a minimum of 21 days between injections. The
      rAd "booster"vaccination is given at Week 24. Participants fill out a diary card at home for
      5 days after each vaccination, recording their temperature and any symptoms. They come to the
      clinic for follow-up 3 days each DNA vaccine injection, and call or return again 7 days after
      each injection. They call a study nurse 1 or 2 days after the rAd injection.

      There are 15 to 18 clinic visits during the course of the study. At each visit, participants
      are checked for health changes or problems. Blood and urine samples are collected at some
      visits. Participants are periodically tested for HIV and asked questions about their sexual
      behavior and drug use and are counseled throughout the study on HIV risk reduction. They are
      also asked about any social effects they may have experienced as a result of their
      participation in this study.
    

Detailed description: 
      Study Design: This is a Phase I randomized study to examine safety and tolerability of, as
      well as immune response to, a schedule of 3 HIV DNA plasmid vaccinations followed by one HIV
      adenoviral vector vaccine (rAd) booster. The hypotheses are that: 1) this regimen will be
      safe for human administration and elicit immune responses to HIV-1; 2) Biojector and
      Needle/Syringe are both safe to use for IM injection of the DNA vaccine and 3) subjects with
      both low and high pre-existing adenovirus serotype 5 antibody (Ad5Ab) titer will have a boost
      in immune response to HIV-1 peptides following the Ad booster vaccination. In this study
      equal numbers of subjects with high and low Ad5Ab titers will be randomized to receive DNA
      vaccinations by either needle and syringe (N/S) or by Biojector and then to receive either
      1010 PU or 1011 PU rAd booster vaccination in a factorial design. The primary objective is to
      evaluate the safety and tolerability in humans of the prime-boost vaccination regimen.
      Secondary objectives are related to evaluation of the immunogenicity of the DNA vaccine when
      administered by N/S or Biojector, the immunogenicity of the Ad vaccine at two different doses
      in subjects with high and low pre-enrollment titers of Ad5Ab, the development of adenovirus
      serotype 5 neutralizing antibody and the social impact of participating in an HIV-1 vaccine
      trial. Exploratory evaluations of the immunogenicity of the prime-boost regimen are also
      planned. The preliminary results may serve as the basis for designing studies to provide more
      definitive answers to questions about method of administration and effect of pre-enrollment
      Ad5Ab titer on safety of and immune response to the rAd booster vaccination.

      Product Description: VRC-HIVDNA016-00-VP is composed of 6 closed, circular DNA plasmids that
      are each 16.67% (by weight) of the vaccine. Each of the 6 plasmids in this vaccine expresses
      a single gene product. Plasmids VRC 4401, VRC 4409 and VRC 4404 are designed to express clade
      B HIV-1 Gag, Pol and Nef, respectively. VRC 5736, VRC 5737, and VRC 5738 are designed to
      express HIV-1 Env glycoprotein from clade A, clade B, and clade C, respectively. Vaccine
      vials will be supplied at 4 mg/mL. DNA vaccinations will be 1 mL of vaccine administered
      intramuscularly using either N/S or the Biojector 2000 Needle-Free Injection Management
      System. VRC-HIVADV014-00-VP is a recombinant product composed of four non-replicating
      adenoviral vectors (in a 3:1:1:1 ratio) that code for HIV-1 Gag/Pol polyproteins from clade B
      and HIV-1 Env glycoproteins from clades A, B, and C. All rAd injections will be administered
      by N/S.

      Subjects: Forty healthy adult volunteers, 18 to 50 years old; 20 subjects with low Ad5Ab
      (1:500) and 20 subjects with high Ad5Ab (greater than 1:500).

      Study Plan: Forty subjects will be randomized in a 1:1 ratio to receive the same vaccination
      schedule but by two different methods of intramuscular administration (N/S or Biojector), as
      shown in the schema. The rAd boost will also be randomized to be either 1010 PU or 1011 PU in
      1:1 ratio. The rAd boost dosage will be blinded until 6 weeks of safety and immunogenicity
      evaluations after the rAd boost are completed for all subjects.
    

Intervention name(s): VRC-HIVDNA016-00-VP; VRC-HIVADV014-00
Intervention type(s): Drug; Drug
Primary purpose: Treatment
Keywords: HIV-Negative; Healthy; Immunity; Preventive; Virus; Healthy Volunteer