A Phase I Study of Quadrivalent Human Papilloma Virus (HPV) (Types 6, 11, 16, 18) Recombinant Vaccine in HIV-Infected and HIV-Negative Pre-Adolescents, Adolescents, and Young Adults
- Conditions
- Papillomavirus VaccinesAdolescentHuman Immunodeficiency VirusHuman Papillomavirus- 6, 11, 16, 18
- Interventions
- Biological: GardasilBehavioral: Survey
- Registration Number
- NCT00798265
- Lead Sponsor
- National Cancer Institute (NCI)
- Brief Summary
Background:
* Human papilloma virus (HPV) is a common sexually transmitted disease. There are more than 100 different HPV types, and both males and females can get HPV infection. Most people do not have any symptoms when they become infected and are able to get rid of the infection on their own. However, they can still become re-infected with the same or a different HPV type, and in some people HPV infection persists.
* Persistent HPV infection is associated with the development of precancerous lesions and cancer. HPV types are classified as either high risk or low risk based on whether their persistence will lead to cancer.
* Patients who have suppressed immune systems are at a higher risk for HPV-related complications. They are more likely to contract multiple HPV types and have more persistent infection that can lead to precancerous lesions or cancer, which are then difficult to treat and often recur.
* A recently approved vaccine for HPV induces immunity to HPV 6, 11, 16, and 18. It was shown to be highly effective in preventing infection with these HPV types, and is approved for use in females 9 to 26 years of age. However, much less is known about the vaccines ability to induce immunity in males or individuals with suppressed immune systems.
Objectives:
- To investigate whether the HPV vaccine is safe to give and able to induce immunity in both female and male adolescents and young adults with HIV infection compared to healthy, human immunodeficiency virus (HIV)-negative persons of the same age.
Eligibility:
- Males and females, 12 to 26 years of age, divided into three groups: (1) Healthy and HIV-negative, (2) HIV-positive and on antiretroviral therapy, and (3) HIV-positive and not on antiretroviral therapy.
Design:
* Before beginning vaccination, participants will have a complete physical examination and blood drawn for routine blood tests, special tests of the immune system, antibody tests, and an HIV test.
* HPV vaccine will be given by injection into the muscle at 0, 2, and 6 months, according to the standard vaccination schedule.
* Patients with HIV infection will be monitored for a week following the first injection to test the level of HIV in the blood 3 days and 5 days after the first injection.
* Participants will also be asked to fill out a 10- to 15-minute Web-based survey about awareness, health behaviors, and personal choices related to risk factors for HIV, HPV, and other sexually transmitted diseases. Participants are not required to fill out the survey to receive the vaccine.
* The total duration of the study is 4 years. During the first year of the study, participants will return for six additional 1-day visits at months 1, 2, 3, 6, 7, and 12. Participants will return for 1-day visits every 6 months for the remaining 3 years.
- Detailed Description
Background:
Human papilloma virus (HPV) is one of the most common sexually transmitted diseases and a significant cause of cutaneous genital warts and anogenital cancer.
Infection with high-risk, oncogenic HPV types, most commonly types 16 and 18, is associated with low and high-grade cervical cellular abnormalities that are precursors to invasive cervical cancer, as well as vulvar and anal cancer, while HPV types 6 and 11 are associated with genital warts.
Persistence of HPV infection is more common in individuals with or at risk for chronic immunosuppression and HIV-infected individuals have a higher prevalence of HPV infection and HPV-associated anogenital disease compared to age-matched human immunodeficiency virus (HIV)-negative controls.
Study Objectives:
To assess the safety and immunogenicity of quadrivalent human papillomavirus (types 6, 11, 16, 18) recombinant vaccine in HIV-infected preadolescents, adolescents and young adults 12-26 years of age.
To determine whether there are differences in HPV vaccine immunogenicity between HIV-infected and HIV negative age-matched controls.
To determine whether there are differences in HPV vaccine immunogenicity between HIV-infected patients receiving highly active antiretroviral therapy (HAART) and those not receiving HAART with similar cluster of differentiation 4 (CD4) and viral load parameters at entry.
To determine whether HPV vaccination alters human immunodeficiency virus type 1 (HIV-1) ribonucleic acid (RNA) levels.
To investigate the impact of CD4 count and HIV-1 RNA levels on HPV vaccine immunogenicity.
To characterize HPV deoxyribonucleic acid (DNA) positivity in the study cohort populations through oral/buccal and anogenital sampling at baseline.
To characterize HPV and HIV knowledge and risk and sexual behaviors in the study cohort populations.
Eligibility:
Individual Cohorts
Cohort 1: HIV-positive, CD4 cell count greater than or equal to 350 cells/mm\^3, HIV-1 RNA level by reverse transcription (RT) polymerase chain reaction (PCR) less than or equal to 20,000 copies/ml, on stable HAART regimen for greater than or equal to 6 months.
Cohort 2: HIV-infected, CD4 cell count greater than or equal to 500 cells/mm\^3, HIV-1 RNA level by RT PCR less than or equal to 20,000 copies/ml, on no antiretroviral treatment.
Cohort 3: healthy, HIV-negative controls All Cohorts
Females and males age 12 to 26 years
Patients must have a hemoglobin greater than or equal to 10.0 gm/dL, neutrophil count (ANC) greater than or equal to 1500/mm\^3, platelet count greater than or equal to 75,000/mm\^3 and prothrombin time (PT) or partial thromboplastin time (PTT) less than or equal to 1.5x upper limit of normal (ULN) (with the exception of patients with known clotting disorders or lupus anticoagulant); serum glutamic-pyruvic transaminase (SGPT)/Serum glutamic oxaloacetic transaminase (SGOT) \< 2/5x ULN, total bilirubin less than or equal to 1.5x ULN unless attributable to protease inhibitor therapy.
Patients must test negative for hepatitis B virus and hepatitis C virus, unless the result is consistent with prior vaccination or prior infection with full recovery.
No use of investigational agents within 4 weeks of study enrollment or use of immunosuppressive or immunomodulating agents within 8 weeks of study entry.
Study Design:
This is a non-randomized, prospective, phase I study of quadrivalent human papillomavirus (types 6, 11, 16, 18) recombinant vaccine.
The study includes 3 cohorts of pre-adolescents, adolescents and young adults 12-26 years of age as outlined under Eligibility Criteria. Each cohort will enroll 35 patients.
All study subjects will receive three doses of HPV vaccine at 0, 2 and 6 months administered IM.
Study participants will be monitored at months 0, 1, 2, 3, 6, 7, and 12 (+/- 2 weeks for each visit, and every 6 months (+/- 30 days) thereafter for 48 months total.
Recruitment & Eligibility
- Status
- TERMINATED
- Sex
- All
- Target Recruitment
- 26
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Cohort 2 - 0.5 mL dose injected intramuscular (IM) Gardasil 0.5 mL dose injected intramuscular (IM) at 0, 2 and 6 months (+/- 2 weeks) and knowledge survey at week 0 Cohort 3 - 0.5 mL dose injected intramuscular (IM) Gardasil 0.5 mL dose injected intramuscular (IM) at 0, 2 and 6 months (+/- 2 weeks) and knowledge survey at week 0 Cohort 1 - 0.5 mL dose injected intramuscular (IM) Gardasil 0.5 mL dose injected intramuscular (IM) at 0, 2 and 6 months (+/- 2 weeks) and knowledge survey at week 0 Cohort 1 - 0.5 mL dose injected intramuscular (IM) Survey 0.5 mL dose injected intramuscular (IM) at 0, 2 and 6 months (+/- 2 weeks) and knowledge survey at week 0 Cohort 2 - 0.5 mL dose injected intramuscular (IM) Survey 0.5 mL dose injected intramuscular (IM) at 0, 2 and 6 months (+/- 2 weeks) and knowledge survey at week 0 Cohort 3 - 0.5 mL dose injected intramuscular (IM) Survey 0.5 mL dose injected intramuscular (IM) at 0, 2 and 6 months (+/- 2 weeks) and knowledge survey at week 0
- Primary Outcome Measures
Name Time Method Immunogenicity of the Quadrivalent Human Papillomavirus (Types 6, 11, 16, 18) Recombinant Vaccine in Human Immunodeficiency Virus (HIV)-Infected Preadolescents, Adolescents and Young Adults 12-26 Years of Age Up to 36 months Immunogenicity was measured by the vaccine-induced antibody response collectively for preadolescents, adolescents and young adults an reported per cohort for participants with HIV and without HIV. Participants' serum was used to check the level of human papillomavirus (HPV) neutralization antibody. Neutralizing antibody is an antibody that can bind to the infectious organism such as viruses and stop the spread of the disease. The antibody level was compared between the participants with HIV and without HIV.
- Secondary Outcome Measures
Name Time Method Research Assays Immunologic Responses for Human Immunodeficiency Virus (HIV) Infected Subjects Only Month 0 only Two collection tubes: 10ml sodium heparin green top tube (GTT) (20ml total) from HIV infected subjects only (Cohorts 1 and 2).
Human Papilloma Virus (HPV) Vaccine Immunogenicity Between Human Immunodeficiency Virus (HIV)-Infected Participants Receiving Highly Active Antiretroviral Therapy (HAART) & Those Not Receiving HAART With Similar T-lymphocytes (CD4) & Viral Load Parameters At study entry Match per the HIV level at study entry to compare between cohort 1 and 2.
Number of Participants With Log Change in Human Immunodeficiency Virus Type 1 (HIV-1) Ribonucleic Acid (RNA) Levels After Human Papilloma Virus (HPV) Vaccination Baseline, and months 1, 3, 7 and 12 Within each cohort, the number of participants with a change in log\^10 HIV-1 RNA levels will be determined between day 1 and day 7 and will be evaluated to see if the values at the two time points are not statistically different from one another. HIV-1 RNA levels below the lower limits of detection (50 copies/ml) will be expressed as 1.69 log\^10 on a logarithmic scale equivalent to 49 copies/ml. There is at least 95% power to detect a change from day 1 to day 7 with an effect size of 1 standard deviation (SD) and a 0.025 two-sided alpha level test (0.05/2 cohorts) after allowing for a Bonferroni adjustment.
Fold Change in Anti-Human Papilloma Virus (HPV) Titer and T-lymphocytes (CD4) Count (Only at Baseline) Months 7, 12, 24 and 36 Fold change in anti-HPV titer with baseline T-lymphocytes (CD4) count. Fold change is a measure of the antibody titer after vaccination divided by the baseline titer.
T-lymphocytes (CD4) Count (Only at Baseline) Baseline Baseline T-lymphocytes (CD4) count.
Number of Participants With Human Papilloma Virus (HPV) Deoxyribonucleic Acid (DNA) Positivity by Oral/Buccal Swabs at Baseline in the Study Cohort Populations Baseline Human papillomavirus (HPV) deoxyribonucleic acid (DNA) positivity by oral/buccal swabs was performed by swabbing the oral/buccal mucosa and
Number of Participants With Human Papillomavirus (HPV) Deoxyribonucleic Acid (DNA) Positivity by Anogenital Swabs Up to 36 months HPV DNA positivity by anogenital swabs was performed by Papanicolaou test (PAP) test. PAPs were not conducted when the participant stated that she was not sexually active.
Number of Participants Who Completed The Youth Risk Behavior Surveillance System (YRBSS) Baseline Here are the number of participants who properly completed (i.e., answered correctly) the YRBSS. The human papilloma virus (HPV) \& human immunodeficiency virus (HIV) knowledge and risk and sexual behaviors was assessed by a middle school or high school version of web-based Youth Risk Behavior Survey developed by Centers for Disease Control and Prevention (CDC). The Youth Risk Behavior Surveillance System (YRBSS) developed by the CDC was used to monitor six categories of priority health risk behaviors among middle school and high school youth: behaviors that contribute to unintentional injuries and violence; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infections; unhealthy dietary behaviors; and physical inactivity and determine the number of participants who answered correctly on the assessment tool (i.e., YRBSS).
Number of Participants With Serum for Human Papilloma Virus (HPV) Antibody Titers Performed by Merck (Competitive Luminex Assay) 0, 1, 2, 3, 6, 7, 12, 18, 24, 30, 36, 42, and 48 hours Participants collection Tube: 10ml red top tube (RTT) send via courier to National Cancer Institute (NCI) FCRF for processing, aliquoting and cryopreservation by Baselar lab. Batched specimens to be sent to Merck for HPV antibody titers.
Functional Human Papilloma Virus (HPV) Antibody Neutralization Assays At 7 months Month 7 anti-HPV Ab titer was correlated with Neutralization Assay (PBNA) antibody titers and analyzed by the secreted alkaline phosphatase (SEAP)/enzyme-linked immunosorbent assay (ELISA) R.
Cryopreserved Peripheral Blood Mononuclear Cells (PBMCs) for Human Papilloma Virus (HPV) & Human Immunodeficiency Virus (HIV) Lymphocyte Proliferation Assays, Cytokine Induction Assay, Luminex Multi-cytokine Profiling of PBMCs 0, 1, 3, 7, 12, 24, 36, and 48 hours Participants collection tube: 6 tubes sodium heparin 10ml green top tube (GTT) (60ml total) send via courier to National Cancer Institute (NCI) FCRF for processing, aliquoting and cryopreservation by Baselar lab according to protocol provided by the investigator. Note: HIV lymphocyte proliferation assays will only be performed in HIV-infected subjects
Extended Fluorescence Activated Cell Sorting (FACS)/Quantitative Lymphocyte Subpopulation Studies 0, 1, 3, 7, 12, 18, 24, 30, 36, 42, and 48 hours Extended FACS/Quantitative lymphocyte subpopulation studies human immunodeficiency virus (HIV)-infected subjects only (Cohorts 1 and 2) using a 10ml sodium heparin green top tube (GTT).
Quantitative Measurement of Human Immunodeficiency Virus (HIV)-Related Chemokines Macrophage Inflammatory Proteins (MIP)-1 Alpha (α), MIP-1 Beta (β) and Regulated Upon Activation, Normal T Cell Expressed and Presumably Secreted (RANTES) 0, 1, 2, 3, 6, 7, 12, 18, 24, 30, 36, 42, and 48 hours Collection tube: 10ml red top tube (RTT) send via courier to National Cancer Institute (NCI) FCRF for processing, aliquoting and cryopreservation by Baselar lab.
Cryopreserved Whole Blood for Human Papilloma Virus (HPV) Deoxyribonucleic Acid (DNA) Testing 0, 7, 12, 24, 36, and 48 Months Three collection tube: 6ml purple top ethylenediamine tetraacetic acid (EDTA) tubes (18ml total)
Trial Locations
- Locations (1)
National Institutes of Health Clinical Center, 9000 Rockville Pike
🇺🇸Bethesda, Maryland, United States