Evaluating the Safety and Efficacy of the VRC01 Antibody in Reducing Acquisition of HIV-1 Infection in Women

Study Description

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Brief Summary:

This study will evaluate the safety and efficacy of the human monoclonal antibody (mAb) VRC-HIVMAB060-00-AB (VRC01) in preventing HIV-1 infection in high-risk, HIV-uninfected women.

Condition or disease	Intervention/treatment	Phase
HIV Infections	Biological: VRC01; Biological: Placebo for VRC01	Phase 2

Detailed Description:

This study will evaluate the safety, tolerability, and efficacy of the VRC01 antibody in preventing HIV-1 infection in healthy women at high risk of HIV infection.

Participants will be enrolled from a cohort of heterosexual women in sub-Saharan Africa. An equal number of study participants will be randomized to receive VRC01 mAb by IV infusion at a dose of 10 mg/kg or 30 mg/kg every 8 weeks, or to receive control infusions every 8 weeks. All participants will receive the VRC01 antibody or placebo by intravenous infusion at Weeks 0 (study entry), 8, 16, 24, 32, 40, 48, 56, 64, and 72. For 3 days following each infusion, participants will be asked to record and report any symptoms to study researchers.

In addition to the infusion visits, participants will attend study visits at Weeks 4, 8 + 5 days, 12, 20, 28, 36, 44, 52, 60, 68, 76, 80, 84, 88, and 92. All study visits will include blood collection and HIV testing and counseling. Select study visits will include a medical history review, physical exam, urine collection, pregnancy testing for participants capable of becoming pregnant, risk reduction counseling, and an interview/questionnaire.

Study Design

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Study Type :	Interventional (Clinical Trial)
Estimated Enrollment :	1900 participants
Allocation:	Randomized
Intervention Model:	Parallel Assignment
Masking:	Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose:	Prevention
Official Title:	A Phase 2b Study to Evaluate the Safety and Efficacy of VRC01 Broadly Neutralizing Monoclonal Antibody in Reducing Acquisition of HIV-1 Infection in Women in Sub-Saharan Africa
Study Start Date :	May 2016
Estimated Primary Completion Date :	September 28, 2020
Estimated Study Completion Date :	September 28, 2020

Arms and Interventions

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Arm	Intervention/treatment
Experimental: Group 1: Low-Dose VRC01; Participants will receive an IV infusion of 10 mg/kg of VRC01 over about 30 to 60 minutes at Weeks 0, 8, 16, 24, 32, 40, 48, 56, 64, and 72.	Biological: VRC01; Administered by IV infusion; total dose will vary based on participant's weight; Other Name: Human monoclonal antibody (mAb) VRC-HIVMAB060-00-AB
Experimental: Group 2: High-Dose VRC01; Participants will receive an IV infusion of 30 mg/kg of VRC01 over about 30 to 60 minutes at Weeks 0, 8, 16, 24, 32, 40, 48, 56, 64, and 72.	Biological: VRC01; Administered by IV infusion; total dose will vary based on participant's weight; Other Name: Human monoclonal antibody (mAb) VRC-HIVMAB060-00-AB
Placebo Comparator: Group 3: Placebo for VRC01; Participants will receive an IV infusion of placebo for VRC01 over about 30 to 60 minutes at Weeks 0, 8, 16, 24, 32, 40, 48, 56, 64, and 72.	Biological: Placebo for VRC01; Sodium Chloride for Injection USP, 0.9%; administered by IV infusion

Outcome Measures

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Primary Outcome Measures :

1. Number of participants with local and systemic reactogenicity signs and symptoms [ Time Frame: Measured through Week 92 ]
2. Number of participants with adverse events (AEs) [ Time Frame: Measured through Week 92 ]
3. Number of participants with severe adverse events (SAEs) [ Time Frame: Measured through Week 92 ]
4. Rates of participant discontinuation from the study [ Time Frame: Measured through Week 92 ]
5. Documented HIV-1 infection by the Week 80 study visit [ Time Frame: Measured through Week 80 ]

Secondary Outcome Measures :

1. Serum concentration of VRC01 in participants assigned to receive the mAb (ELISA, neutralizing assay) [ Time Frame: Measured through Week 92 ]
2. Serum mAb effector functions to HIV-1 Envs representing variability of the VRC01 antibody footprint [ Time Frame: Measured through Week 92 ]
3. Sequences of breakthrough HIV infections from the earliest available HIV-positive plasma samples [ Time Frame: Measured through Week 92 ]
4. VRC01 neutralization-sensitivity of, and effector function against, HIV strains from infected trial participants from the earliest available post-HIV-infection serum samples [ Time Frame: Measured through Week 92 ]

Eligibility Criteria

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Ages Eligible for Study:	18 Years to 50 Years (Adult)
Sexes Eligible for Study:	Female
Accepts Healthy Volunteers:	Yes

Criteria

Inclusion Criteria:

General and Demographic Criteria

• Age of 18 to 50 years
• Access to a participating clinical research site (CRS) and willingness to be followed for the planned duration of the study
• Ability and willingness to provide informed consent
• Assessment of understanding: volunteer demonstrates understanding of this study and completes a questionnaire prior to first infusion with verbal demonstration of understanding of all questionnaire items answered incorrectly
• Agrees not to enroll in another study of an investigational research agent for the duration of the participant's trial participation
• Good general health as shown by medical history, physical exam, and screening laboratory tests

HIV-Related Criteria

• Willingness to receive HIV test results
• Willingness to discuss HIV infection risks and amenable to HIV risk reduction counseling
• Persons born Female (assigned female sex at birth) and identifying as a female, who, in the 6 months prior to randomization, has had vaginal and/or anal intercourse with a male partner
• All volunteers who have been in a monogamous relationship with an HIV-1 seronegative partner for greater than 1 year are excluded.

Laboratory Inclusion Values+

Hematology

• Hemoglobin (Hgb) greater than or equal to 10.5 g/dL for volunteers who were born female, greater than or equal to 13.0 g/dL for volunteers who were born male
• Platelets greater than or equal to 100,000 cells/mm^3

Chemistry

• Alanine aminotransferase (ALT) less than 2.5 times the institutional upper limit of normal and creatinine less than or equal to 1.25 times the institutional upper limit of normal

Virology

• HIV uninfected, as defined in the study specific procedures (SSP), within 30 days prior to enrollment

Urine

• Negative, trace, or 1+ urine protein by dipstick

Reproductive Status

• Volunteers capable of becoming pregnant: negative serum or urine beta human chorionic gonadotropin (β-HCG) pregnancy test performed at the screening visit and prior to infusion on the day of initial infusion. Persons who are NOT capable of becoming pregnant 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 is capable of becoming pregnant must agree to consistently use effective contraception (see the protocol and SSP for more information) for sexual activity that could lead to pregnancy from at least 21 days prior to enrollment through the last required protocol clinic visit.
• Volunteers capable of becoming pregnant 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

• Investigational research agents received within 30 days before first infusion
• Body mass index (BMI) greater than or equal to 40
• Pregnant or breastfeeding
• Any reactive, indeterminate, or positive HIV test, even if subsequent testing indicates that the individual is not HIV infected.

Monoclonal antibodies and vaccines

• Previous receipt of humanized or human monoclonal antibodies (mAbs), whether licensed or investigational
• HIV vaccine(s) received in a prior HIV vaccine trial. For volunteers who have received control/placebo in an HIV vaccine trial, the HVTN 703/HPTN 081 Protocol Safety Review Team (PSRT) will determine eligibility on a case-by-case basis.

Immune System

• Serious adverse reactions to VRC01 formulation components such as sodium citrate, sodium chloride, and L-arginine hydrochloride, including history of anaphylaxis and related symptoms such as hives, respiratory difficulty, angioedema, and/or abdominal pain.
• Autoimmune disease, including Type I diabetes mellitus (Not excluded from participation: Volunteer with mild, stable and uncomplicated autoimmune disease that does not require consistent immunosuppressive medication and that, in the judgment of the site investigator, is likely not subject to exacerbation and likely not to complicate reactogenicity and adverse event (AE) assessments)
• Immunodeficiency syndrome

Clinically significant medical conditions

• Clinically significant medical condition, physical examination findings, clinically significant abnormal laboratory results, or past medical history with clinically significant implications for current health. A clinically significant condition or process includes but is not limited to:

  • Any contraindication to repeated infusions or blood draws, including inability to establish venous access;
  • 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; or
  • A condition or process for which signs or symptoms could be confused with reactions to VRC01.
• 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 infusion reactions, 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.
• Asthma, other than mild, well-controlled asthma
• Bleeding disorder diagnosed by a doctor (e.g., 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.
• History of hereditary angioedema, acquired angioedema, or idiopathic angioedema
• History of organ or tissue transplantation
• Known hepatic or renal dysfunction

Contacts and Locations

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Locations

Botswana
Gaborone CRS
Gaborone, South-East District, Botswana
Kenya
Kisumu Crs
Kisumu, Nyanza, Kenya, 40100
Malawi
Blantyre CRS
Blantyre, Southern Region, Malawi
Malawi CRS
Lilongwe, Malawi
Mozambique
Polana Canico Health Research and Training Center (CISPOC), National Institute of Health (INS) CRS
Maputo, Mozambique
South Africa
Aurum Tembisa CRS
Johannesburg, Gauteng, South Africa, 1632
Soweto HVTN CRS
Johannesburg, Gauteng, South Africa, 1862
Ward 21 CRS
Johannesburg, Gauteng, South Africa, 2001
Wits Reproductive Health and HIV Institute CRS (WRHI CRS)
Johannesburg, Gauteng, South Africa, 2038
Synexus Stanza Clinical Research Centre CRS
Pretoria, Gauteng, South Africa, 0122
Botha's Hill CRS
Durban, Kwa Zulu Natal, South Africa, 3660
Chatsworth CRS
Chatsworth, KwaZulu-Natal, South Africa, 4030
CAPRISA eThekwini CRS
Durban, KwaZulu-Natal, South Africa, 4013
Vulindlela CRS
Durban, KwaZulu-Natal, South Africa, 4013
Aurum Institute Klerksdorp CRS
Klerksdorp, North West Province, South Africa, 2571
Rustenburg CRS
Rustenburg, North West Province, South Africa, 0300
Groote Schuur HIV CRS
Cape Town, Western Cape Province, South Africa, 7925
Tanzania
National Institute for Medical Research (NIMR) - Mbeya Medical Research Center (MMRC) Network CRS
Mbeya, Tanzania
Zimbabwe
Seke South CRS
Chitungwiza, Zimbabwe
Parirenyatwa CRS
Harare, Zimbabwe
Spilhaus CRS
Harare, Zimbabwe

Sponsors and Collaborators

National Institute of Allergy and Infectious Diseases (NIAID)

Investigators

Study Chair:	Lawrence Corey	HVTN; FHCRC
Study Chair:	Myron Cohen	HPTN; University of North Carolina

More Information

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Responsible Party:	National Institute of Allergy and Infectious Diseases (NIAID)
ClinicalTrials.gov Identifier:	NCT02568215 History of Changes
Other Study ID Numbers:	HVTN 703/HPTN 081; 12045 ( Registry Identifier: DAIDS-ES Registry Number )
First Posted:	October 5, 2015
Last Update Posted:	October 18, 2018
Last Verified:	October 2018

Keywords provided by National Institute of Allergy and Infectious Diseases (NIAID):

HIV-1 Infections

Additional relevant MeSH terms:

Infection; Communicable Diseases; HIV Infections; Lentivirus Infections; Retroviridae Infections; RNA Virus Infections; Virus Diseases; Sexually Transmitted Diseases, Viral	Sexually Transmitted Diseases; Immunologic Deficiency Syndromes; Immune System Diseases; Antibodies; Immunoglobulins; Antibodies, Monoclonal; Immunologic Factors; Physiological Effects of Drugs