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Evaluating Safety and Immune Response to the HIV-1 CH505 Transmitted/Founder gp120 Adjuvanted With GLA-SE in Healthy, HIV-exposed Uninfected Infants

Phase 1
Completed
Conditions
HIV Infections
Interventions
Biological: CH505TF gp120
Biological: Placebo
Biological: GLA-SE adjuvant
Registration Number
NCT04607408
Lead Sponsor
HIV Vaccine Trials Network
Brief Summary

This study evaluated the safety and immune response in healthy HIV-exposed and uninfected infants to the protein vaccine, CH505TF gp120, adjuvanted with GLA-SE.

Detailed Description

This study evaluated evaluate the safety and immune response in healthy HIV-exposed and uninfected infants to the protein vaccine, CH505TF gp120, adjuvanted with GLA-SE.

This study enrolled 38 mother-infant pairs. To quantify the maternal HIV antibody response, mothers were also enrolled in the study but not received study product. Infants received the CH505TF gp120 protein adjuvanted with GLA-SE at Weeks 0, 8, 16, 32, and 54. The first dose was given within the first five days of life.

The study was conducted in three parts (Parts A, B, and C), and to ensure safety, enrollment proceeded in stages.

Part A (Initial Safety) enrolled first. 5 infants in Part A received a low dose of protein with a low dose of adjuvant and 2 infants received placebo.

After safety review post first vaccination of infants in Part A, Part B enrolled. In Part B (Safety Ramp-Up), 2 infants received a higher dose of protein with a higher dose of adjuvant and 2 infants received placebo.

After safety review post first vaccination of infants in Part B, Part C enrolled. In Part C (Immunogenicity), 5 infants received low dose protein with higher dose of adjuvant, 16 infants received a higher dose of protein with higher dose of adjuvant, and 6 infants received placebo.

There were 14 scheduled clinic visits over 24.5 months. For infants, study visits included some or all of the following: physical examinations, medical history, vaccine injections, HIV testing, and blood, cord blood, and stool collection. For mothers, study visits included some or all of the following: medical history, physical examinations, questionnaires, risk reduction counseling, and blood, breastmilk, and stool collection.

Recruitment & Eligibility

Status
COMPLETED
Sex
All
Target Recruitment
38
Inclusion Criteria
  • Born via Caesarean section to an HIV-1-infected woman who meets all maternal inclusion/exclusion criteria listed below.
  • Estimated gestational age at birth is at least 37 weeks.
  • Weight at birth is at least 2.5 kg.
  • Has initiated antiretroviral prophylaxis consistent with current site-specific standard of care.
  • Hemoglobin >14.0 g/dL.
  • White Blood Cell Count ≥ 7000 cells/mm3
  • Platelets > 100,000 cells/mm3
  • Alanine aminotransferase (ALT) <1.25 times upper limit of age adjusted normal.
  • Creatinine < 1.1 times upper limit of age adjusted normal.
  • Negative HIV-1 nucleic acid test on specimen drawn within 72 hours of birth.
  • Written informed consent provided by mother.
  • Age is equal to or less than five days.

Infant

Exclusion Criteria
  • Any clinically significant congenital anomaly/birth defect.
  • Documented or suspected serious medical illness, infection, clinically significant finding from physical examination or immediate life-threatening condition, including requirement for ongoing supplemental oxygen, as judged by the examining clinician.
  • Receipt of or anticipated need for blood products, immunoglobulin, or immunosuppressive therapy. This includes infants who require Hepatitis B Immunoglobulin (HBIG) but does not require exclusion of infants who receive Hepatitis B vaccine in the newborn period.
  • Receipt of any other investigational product.

Mother Inclusion Criteria:

  • Mother's age is at least 18 years, and willing and able to provide written informed consent for her and her infant's participation in this study.
  • Mother is in the second or third trimester of singleton pregnancy, as determined by a clinical exam, or sonography and reported menstrual history.
  • Mother agrees to donate umbilical cord blood.
  • Mother has a planned Caesarian Section at Chris Hani Baragwanath Academic Hospital, Soweto and plans to remain in the area after delivery.
  • Mother is determined by the site investigator to be in good overall health at the time of delivery based on medical history, and physical exam.
  • Mother has a documented CD4 count > 350 cells/microliter during her pregnancy.
  • Mother has a documented SARS-CoV-2 negative PCR test within 2 days before delivery to 5 days after delivery
  • Mother has access to the participating HVTN CRS and willingness to be followed for the planned duration of the study.
  • Assessment of understanding: Mother demonstrates understanding of this study; completes a questionnaire prior to delivery with verbal demonstration of understanding of all questionnaire items answered incorrectly.
  • Mother agrees not to enroll either herself or her infant in another research study for the duration of the trial without prior approval of the HVTN 135 PSRT.
  • Mother has confirmed HIV-1 infection documented by medical records at any time during or prior to screening, and confirmed by the HVTN CRS by serology.
  • Mother has been on cART for at least sixteen weeks prior to delivery and intends to continue with cART for the duration of breastfeeding.\
  • Mother has a viral load of less than 400 copies/mL between two weeks before and 5 days after delivery.

Mother Exclusion Criteria:

  • Any WHO Grade IV illness within one year prior to study enrollment as determined by the history and physical examination and review of the medical record (if available). These include HIV wasting syndrome, PJP Pneumonia, Cerebral Toxoplasmosis, extrapulmonary Cryptococcosis, Progressive Multifocal Leukoencephalopathy, any disseminated endemic mycosis (histoplasmosis), candidiasis of the esophagus, trachea, bronchi or lung, disseminated atypical mycobacteria, non-typhoid Salmonella septicemia, extrapulmonary tuberculosis, lymphoma, Kaposi's sarcoma.
  • Prior participation in any HIV-1 vaccine or anti-HIV antibody-mediated prevention trial.
  • Receipt of any investigational agent during this pregnancy.
  • Receipt of blood products, immunoglobulin, or immunomodulating therapy within 45 days prior to delivery of the placenta.
  • 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.
  • Any condition that places the newborn at higher risk of early-onset sepsis, such as concern for active maternal infection at delivery as determined by local site investigators (eg, fever).
  • Detectable Hepatitis B surface antigen.

Study & Design

Study Type
INTERVENTIONAL
Study Design
SEQUENTIAL
Arm && Interventions
GroupInterventionDescription
Part A, Group 1: CH505TF gp120 + GLA-SECH505TF gp120Participants received 20 mcg Stable CH505TF gp120 admixed with 2.5 mcg GLA-SE, administered as a 0.25 mL intramuscular (IM) injection into either thigh at Weeks 0, 8, 16, 32, and 54.
Part A, Group 1: CH505TF gp120 + GLA-SEGLA-SE adjuvantParticipants received 20 mcg Stable CH505TF gp120 admixed with 2.5 mcg GLA-SE, administered as a 0.25 mL intramuscular (IM) injection into either thigh at Weeks 0, 8, 16, 32, and 54.
Part A, Group 2: PlaceboPlaceboParticipants received Placebo administered as a 0.25 mL IM injection, into either thigh at Weeks 0, 8, 16, 32, and 54.
Part B, Group 3: CH505TF gp120 + GLA-SECH505TF gp120Participants received 20 mcg Stable CH505TF gp120 admixed with 5 mcg GLA-SE, administered as a 0.5 mL IM injection into either thigh at Weeks 0, 8, 16, 32, and 54.
Part B, Group 3: CH505TF gp120 + GLA-SEGLA-SE adjuvantParticipants received 20 mcg Stable CH505TF gp120 admixed with 5 mcg GLA-SE, administered as a 0.5 mL IM injection into either thigh at Weeks 0, 8, 16, 32, and 54.
Part B, Group 4: PlaceboPlaceboParticipants received Placebo administered as a 0.5 mL IM injection, into either thigh at Weeks 0, 8, 16, 32, and 54.
Part C, Group 5: CH505TF gp120 + GLA-SECH505TF gp120Participants received 20 mcg Stable CH505TF gp120 admixed with 5 mcg GLA-SE, administered as a 0.5 mL IM injection into either thigh at Weeks 0, 8, 16, 32, and 54.
Part C, Group 5: CH505TF gp120 + GLA-SEGLA-SE adjuvantParticipants received 20 mcg Stable CH505TF gp120 admixed with 5 mcg GLA-SE, administered as a 0.5 mL IM injection into either thigh at Weeks 0, 8, 16, 32, and 54.
Part C, Group 6: PlaceboPlaceboParticipants received Placebo administered as a 0.5 mL IM injection, into either thigh at Weeks 0, 8, 16, 32, and 54.
Part C, Group 7: CH505TF gp120 + GLA-SECH505TF gp120Participants received 5 mcg Stable CH505TF gp120 admixed with 5 mcg GLA-SE, administered as a 0.5 mL IM injection into either thigh at Weeks 0, 8, 16, 32, and 54.
Part C, Group 7: CH505TF gp120 + GLA-SEGLA-SE adjuvantParticipants received 5 mcg Stable CH505TF gp120 admixed with 5 mcg GLA-SE, administered as a 0.5 mL IM injection into either thigh at Weeks 0, 8, 16, 32, and 54.
Part C, Group 8: PlaceboPlaceboParticipants received Placebo administered as a 0.5 mL IM injection, into either thigh at Weeks 0, 8, 16, 32, and 54.
Primary Outcome Measures
NameTimeMethod
WHO Anthropometric Measure of Weight-for-Age Z-ScoreMeasured at each study visit.

At each study visit, the infant's weight was measured. Using weight and age, a WHO weight-for-age z-score will be calculated using the World Health Organization (WHO) anthropometric calculator tool. Weight-for-age reflects body weight relative to the child's age on a given day. A Z-score of 0 represents the population mean, a Z-score less than -2 indicates an infant who is underweight, -2 to 2 indicates an infant who is normal weight, and above 2 indicates the infant may have a growth problem, but this is better assessed from weight-for-length.

This Outcome Measure was not collected for Mothers.

Number (Percentage) of Participants by WHO Anthropometric Measure of Weight-for-Age Z-Score CategoriesMeasured at each study visit.

At each study visit, the infant's weight was measured. Using weight and age, a WHO weight-for-age z-score was calculated using the World Health Organization (WHO) anthropometric calculator tool. Weight-for-age reflects body weight relative to the child's age on a given day. Z-scores less than -2 indicates an infant who is underweight, -2 to 2 indicates an infant who is normal weight, and above 2 indicates the infant may have a growth problem, but this is better assessed from weight-for-length.

WHO Anthropometric Measure of Weight-for-Length Z-ScoreMeasured at each study visit.

At each study visit, the infant's length and weight was measured. Using these measurements, a WHO weight-for-length z-score was calculated using the World Health Organization (WHO) anthropometric calculator tool. Weight-for-length reflects body weight in proportion to attained growth in length. A Z-score of 0 represents the population mean, a Z-score less than -2 indicates an infant who is wasted, -2 to 2 indicates an infant who is normal weight, and above 2 indicates the infant is overweight.

This Outcome Measure was not collected for Mothers.

Number (Percentage) of Participants by WHO Anthropometric Measure of Weight-for-Length Z-Score CategoriesMeasured at each study visit.

At each study visit, the infant's length and weight was measured. Using these measurements, a WHO weight-for-length z-score was calculated using the World Health Organization (WHO) anthropometric calculator tool. Weight-for-length reflects body weight in proportion to attained growth in length. Z-scores less than -2 indicates an infant who is wasted, -2 to 2 indicates an infant who is normal weight, and above 2 indicates the infant is overweight.

Number of Participants Reporting Local Reactogenicity Signs and Symptoms: Pain and/or TendernessMeasured through 7 days after each vaccine dose (Weeks 0, 8, 16, 32, 54).

Graded according to the Division of AIDS (DAIDS) Table for Grading the Severity of Adult and Pediatric Adverse Events, Version 2.1 \[July 2017\]. The maximum grade observed for each symptom over the time frame is presented.

This Outcome Measure was not collected for Mothers.

Number of Participants Reporting Local Reactogenicity Signs and Symptoms: Erythema and/or IndurationMeasured through 7 days after each vaccine dose (Weeks 0, 8, 16, 32, 54).

Graded according to the Division of AIDS (DAIDS) Table for Grading the Severity of Adult and Pediatric Adverse Events, Version 2.1 \[July 2017\]. The maximum grade observed for each symptom over the time frame is presented.

This Outcome Measure was not collected for Mothers.

Number of Participants Reporting Systemic Reactogenicity Signs and SymptomsMeasured through 7 days after each vaccine dose (Weeks 0, 8, 16, 32, 54).

Graded according to the Division of AIDS (DAIDS) Table for Grading the Severity of Adult and Pediatric Adverse Events, Version 2.1 \[July 2017\]. The following symptoms are considered as systemic reactogenicity if the onset date was within the periods of assessment specified in the protocol: fever, sleepiness/lethargy, rash, vomiting, anorexia, seizure. The item Max. Systemic Symptoms is the maximum of the individual systemic reactogenicities for a participant.

This Outcome Measure was not collected for Mothers.

Number (Percentage) of Participants With Local Laboratory Values Recorded as Meeting Grade 1 AE Criteria or Above as Specified in the Division of AIDS Table.ALT, creatinine, hemoglobin, platelets, and WBC measured at Screening (Day 0) and Days 14, 70, 126, 238, 393, 743; Lymphocytes and Neutrophils measured at Days 14, 70, 126, 238, 393, 743.

The number (percentage) of participants with local laboratory values recorded as meeting Grade 1 AE criteria or above as specified in the Division of AIDS Table for Grading the Severity of Adult and Pediatric Adverse Events for alanine aminotransferase (ALT), creatinine, hemoglobin, lymphocyte count, neutrophil count, platelets, white blood cells (WBC) was summarized by treatment arm for each post vaccination time point.

This Outcome Measure was not collected for Mothers.

Number of Participants Reporting AEs, by Highest Severity Grade Per Participant.Comprises the entire study period for each infant participant (from the infant's study enrollment until his or her study completion or discontinuation), up to 25 months.

Graded according to the Division of AIDS (DAIDS) Table for Grading the Severity of Adult and Pediatric Adverse Events, Corrected Version 2.1, July 2017 (exceptions apply).

This Outcome Measure was not collected for Mothers.

Number of Participants Reporting Adverse Events (AEs), by Relationship to Study ProductComprises the entire study period for each infant participant (from the infant's study enrollment until his or her study completion or discontinuation), up to 25 months.

Graded according to the Division of AIDS (DAIDS) Table for Grading the Severity of Adult and Pediatric Adverse Events, Corrected Version 2.1, July 2017 (exceptions apply).

This Outcome Measure was not collected for Mothers.

Number of Participants Reporting Serious Adverse Events (SAEs)Comprises the entire study period for each infant participant (from the infant's study enrollment until his or her study completion or discontinuation), up to 25 months.

Graded according to the Division of AIDS (DAIDS) Table for Grading the Severity of Adult and Pediatric Adverse Events, Corrected Version 2.1, July 2017 (exceptions apply).

This Outcome Measure was not collected for Mothers.

Secondary Outcome Measures
NameTimeMethod

Trial Locations

Locations (1)

Perinatal HIV Research Unit (PHRU), Soweto CRS

🇿🇦

Johannesburg, Gauteng, South Africa

Perinatal HIV Research Unit (PHRU), Soweto CRS
🇿🇦Johannesburg, Gauteng, South Africa

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