Evaluating HIV-1 Neutralization Antibody Breadth in Response to HIV gp120 Protein Vaccine in HIV-uninfected Adults With Quiescent Systemic Lupus Erythematosus
Condition: HIV Infections; Systemic Lupus Erythematosus
MeSH terms: Lupus Erythematosus, Systemic
Intervention: AIDSVAX® B/E
Intervention description: Administered by intramuscular injection
Phase: Phase 1
Study type: Interventional
Primary purpose: Prevention
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 1.0
Sex: All
Minimum age: 18 Years
Maximum age: 50 Years
Healthy volunteers: No

Summary:

      The purpose of this study is to evaluate the breadth and potency of HIV-1 neutralizing
      antibody (nAb) responses and examine the safety and tolerability of an HIV gp120 protein
      vaccine (AIDSVAX® B/E) in HIV-uninfected adults diagnosed with Systemic Lupus Erythematosus
      (SLE) who have stable disease.
    

Eligibility criteria:

        Inclusion Criteria:

        General and Demographic Criteria

          -  Age of 18 to 50 years

          -  Weight greater than 110 pounds

          -  Meets American College of Rheumatology (ACR) criteria for the classification of SLE
             with serologic evidence of disease including a positive test for antinuclear
             antibodies at a titer of 1:640 or greater, or the presence of a positive test for
             antibodies to double-strand DNA (dsDNA), or the presence of anti-Sm, anti-RNP, or
             anti-Ro antibodies, as documented by medical records and as assessed by a
             rheumatologist or designee.

          -  Currently taking hydroxychloroquine for SLE and for at least 6 months prior to
             enrollment

          -  Access to a participating HIV Vaccine Trials Network (HVTN) clinical research site
             (CRS) and willingness to be followed for the planned duration of the study

          -  Ability and willingness to provide informed consent

          -  Allows ongoing access to medical records pertaining to their rheumatologic disease

          -  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

        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 (see protocol for more information)

        Laboratory Inclusion Values

        Hemogram/Complete blood count (CBC)

          -  Hemoglobin greater than or equal to 11.0 g/dL for volunteers who were assigned female
             sex at birth, greater than or equal to 12.0 g/dL for volunteers who were assigned male
             sex at birth.

          -  White blood cell count equal to 2,500 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 100,000 to 550,000/mm^3

        Chemistry

          -  Chemistry panel: alanine amino transferase (ALT) and aspartate aminotransferase (AST)
             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: volunteers must have a negative US Food and Drug
             Administration (FDA)-approved enzyme immunoassay (EIA) within 56 days prior to
             enrollment.

          -  Negative Hepatitis B surface antigen (HBsAg) within 56 days prior to enrollment

          -  Negative anti-Hepatitis C virus antibodies (anti-HCV), or negative HCV polymerase
             chain reaction (PCR) if the anti-HCV is positive within 56 days prior to enrollment

        Urine

          -  Normal urine by urinalysis:

               -  Negative urine glucose, and

               -  Negative or trace urine protein, and

               -  Red blood cell (RBC) levels within institutional normal range, and

               -  No RBC casts

        Reproductive Status

          -  Volunteers who were assigned female sex at birth: negative serum or urine beta human
             chorionic gonadotropin (β-HCG) pregnancy test in accordance with local regulatory
             requirements, 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: A volunteer who was assigned female sex at birth must:

               -  Agree to use effective contraception 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 is defined as using the following
                  methods:

                    -  Condoms (male or female) with or without a spermicide,

                    -  Diaphragm or cervical cap with spermicide,

                    -  Intrauterine device (IUD),

                    -  Hormonal contraception, or

                    -  Any other contraceptive method approved by the HVTN 121 Protocol Safety
                       Review Team (PSRT)

                    -  Successful vasectomy in any partner assigned male sex at birth (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 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 assigned female sex at birth 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

        Exclusion Criteria:

        General

          -  Blood products received within 120 days before first vaccination

          -  Investigational research agents not used to treat SLE received within 30 days before
             first vaccination (additional exclusions may apply, see criteria below)

          -  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 121 study

          -  Pregnant or breastfeeding

          -  Active duty and reserve US military personnel

        SLE status. The following criteria must be verified by a rheumatologist or designee

          -  Currently with active lupus as defined by a Systemic Lupus Erythematosus Disease
             Activity Index (SELENA-SLEDAI) greater than 4 (see protocol for more information).

          -  Documented SLEDAI score of greater than 20 in medical record at any time indicating
             severe activity, or evidence of moderate disease activity (SELENA-SLEDAI greater than
             6) within the last six months, (see protocol for more information).

          -  Has had a condition listed on the Systemic Lupus International Collaborating
             Clinics/American College of Rheumatology Damage Index (SLICC/ACR DI) or has had an
             increase in the SLICC/ACR D1 score within the last 12 months other than cataracts,
             premature ovarian failure or diabetes mellitus with approval of the PSRT
             http://www.clinexprheumatol.org/article.asp?a=2697

          -  A history of central nervous system (CNS) disease

          -  Thrombotic event within the past 12 months in association with confirmed
             antiphospholipid antibody

          -  A history of renal disease (SLE-related renal injury) confirmed by prior biopsy,
             active urine sediment, or proteinuria

          -  Prednisone dose greater than 10 mg/day for more than 6 months within the past year

          -  Administration of anti-B-cell therapy (rituximab or belimumab) or any investigational
             research agents used to treat SLE within the preceding 2 years

          -  Administration of cyclophosphamide within the preceding year; or administration of
             mycophenolate mofetil within the last 6 months; or administration of methotrexate,
             leflunomide, or azathioprine within the last 3 months

          -  Administration of any investigational immunosuppressant medication within the last
             year

          -  Administration of other immunosuppressive medications not listed above, with the
             exception of topical steroids, topical immunosuppressives (eg, cyclosporine, FK506),
             or ophthalmic immunosuppressives (eg, steroids, cyclosporine), within 6 months before
             first vaccination, unless approved by the HVTN 121 PSRT

        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 121 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 by the HVTN 121 PSRT for vaccines that have subsequently
             undergone licensure by the FDA. For volunteers who have received control/placebo in an
             experimental vaccine trial, the HVTN 121 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
             121 PSRT on a case-by-case basis.

          -  Vaccines received within 30 days before first study vaccination or scheduled within 30
             days after injection (eg, influenza, tetanus, pneumococcal, Hepatitis A or B, measles,
             mumps, and rubella [MMR]; oral polio vaccine [OPV]; varicella; yellow fever)

          -  Allergy treatment with antigen injections within 30 days before first vaccination or
             that are scheduled within 14 days after first vaccination

        Immune System

          -  Serious adverse reactions to vaccines or to vaccine components (such as yeast protein,
             amorphous aluminum hydroxyphosphate sulfate, L-histidine, polysorbate 80, sodium
             borate), 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

          -  Immunodeficiency, such as common variable immunodeficiency

        Clinically significant medical conditions

          -  Ongoing bleeding or hemorrhage (excluding menstruation), or any subject on
             anticoagulant therapy

          -  Clinically significant medical condition, physical examination findings, clinically
             significant abnormal laboratory results, or past medical history with clinically
             significant implications for current health, other than SLE and its manifestations. 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 exclusion criteria: Asthma other than mild, well-controlled asthma. (Symptoms
             of asthma severity as defined in the most recent 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.

          -  Uncontrolled diabetes mellitus, Hb A1C greater than 7.0. (not excluded: history of
             isolated gestational diabetes.)

          -  Uncontrolled hypertension:

               -  If a person has a history of hypertension, or is found to have elevated blood
                  pressure or hypertension during screening, 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 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 three 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 (not excluded:
             splenectomy for splenic trauma)

          -  History of hereditary angioedema, acquired angioedema, or idiopathic angioedema.