Safety of and Immune Response to the Human Papillomavirus (HPV) Vaccine in HIV-Infected Women
Condition: HIV Infections; Sexually Transmitted Diseases
MeSH terms: Sexually Transmitted Diseases
Study type: Interventional
Phase: Phase 2

Summary: 
      Human papillomavirus (HPV) is the most common sexually transmitted disease in the world. HPV
      infection can cause genital warts and certain cervical problems, including cervical cancer.
      HPV infection may be more severe and harder to treat in HIV-infected people. The purpose of
      this study was to determine whether the quadrivalent HPV vaccine is safe, tolerable, and
      effective in producing antibodies to HPV in HIV-infected women.
    

Detailed description: 
      HPV is a DNA virus that affects both men and women. Approximately 90 types of HPV have been
      identified, 30 of which are sexually transmitted. The most common forms of HPV are types 6,
      11, 16, and 18. The quadrivalent HPV vaccine that was tested in this study had been shown in
      previous studies to be effective in preventing infection with HPV 6, 11, 16, and 18 in
      healthy young women. According to a report by the Centers for Disease Control and Prevention
      (CDC), 80% of women will have acquired HPV by the age of 50. HIV infected women have been
      reported to have a higher prevalence and persistence of HPV infection, as well as an
      increased risk for abnormal Pap smears and cervical cancer. HPV types 16 and 18 cause the
      majority of cervical cancers worldwide, and types 6 and 11 are responsible for the majority
      of cases of genital warts. Vaccinations for preventable infections are particularly important
      among HIV infected people because people with HIV have compromised immune systems; therefore,
      any infection is very serious and can potentially be fatal. However, standard vaccination
      series have not been very successful because a compromised immune system may not produce the
      desired immune response to a vaccine. The HPV vaccine is designed to protect against
      infection with HPV types 6, 11, 16, and 18 and has been approved by the FDA for use in women
      between the ages of 9 and 26. The purpose of this study was to determine whether the
      quadrivalent HPV vaccine is safe, tolerable, and effective in producing antibodies to HPV in
      HIV infected females.

      The study consisted of single arm evaluations of HPV vaccine immunogenicity and safety in 3
      groups based on the study screening CD4 cell count as follows:

        -  Stratum A: CD4 cell count >350 cells/mm^3

        -  Stratum B: CD4 cell count >200 to <=350 cells/mm^3

        -  Stratum C: CD4 cell count <=200 cells/mm^3

      In Version 1.0 of the protocol, the target accrual was n=67 participants with screening HIV
      viral load <=10,000 copies/mL and n=67 participants with HIV viral load >10,000 copies/mL
      within each CD4 stratum, yielding n=134 in each CD4 stratum. In light of subsequent findings
      from completed HPV vaccine studies, the sample size was changed to n=94 participants per CD4
      stratum in Version 2.0 of the protocol, and stratification by screening HIV viral load was
      removed. All Stratum A and Stratum B participants were enrolled under protocol Version 1.0.

      The study duration was 72 weeks. All participants received HPV vaccine administered by
      intramuscular injection at baseline, and at Weeks 8 and 24. Following each injection,
      participants remained at the clinic for 30 minutes of observation for adverse events. A
      telephone follow-up or a home visit by study staff was performed within 2 days following each
      injection.

      Participants returned to the clinic for visits at Weeks 4, 8, 12, 24, 28, 52, and 72. Most
      study visits included a physical exam, medication review, blood and urine collection, and
      answering questions about signs and symptoms since previous visit. Some visits included
      measurement of HIV viral load and CD4 cell count; collection of endocervical wick, cervical
      cytobrush and anal swab; and an oral exam. A subset of participants were asked to provide
      additional blood samples and oral cytobrush specimens.
    

Intervention name(s): Quadrivalent HPV vaccine
Intervention type(s): Biological
Intervention description(s): Quadrivalent HPV (types 6, 11, 16, 18) recombinant vaccine. All participants received the vaccine via intramuscular injection at baseline, Week 8 and Week 24.
Other intervention name(s): GARDASIL
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: HIV; HPV 6; HPV 11; HPV 16; HPV 18; Vaccine