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A Randomized, Double-Blinded, Placebo-Controlled, Phase III Trial of the Quadrivalent HPV Vaccine to Prevent Anal Human Papillomavirus Infection in HIV-Infected Men and Women


Phase 3
27 Years
N/A
Open (Enrolling)
Both
HIV Infections

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Trial Information

A Randomized, Double-Blinded, Placebo-Controlled, Phase III Trial of the Quadrivalent HPV Vaccine to Prevent Anal Human Papillomavirus Infection in HIV-Infected Men and Women


Anal HPV infection can be a risk factor for anal cancer, which is a common non-AIDS-defining
cancer among HIV-infected MSM. Screening for anal cancer is not widely available and can be
difficult to implement. People who receive the FDA-approved quadrivalent HPV vaccine,
Gardasil, may have a reduced risk of developing anal HPV infection, which may in turn reduce
the risk of developing anal cancer. The purpose of this study is to evaluate the
effectiveness of the quadrivalent HPV vaccine, Gardasil, at reducing the incidence of anal
HPV infections in HIV-infected MSM and HIV-infected women.

This study will enroll HIV-infected MSM and HIV-infected women. Participants will be
randomly assigned to receive the HPV vaccine or a placebo vaccine. At the screening study
visit, participants will undergo a physical examination, blood collection, anal swab
procedure, oral examination, questionnaires, a high-resolution anoscopy (HRA), and if
female, a pregnancy test, vaginal swab, and gynecologic exam. At the entry study visit,
participants will undergo most of the procedures performed at screening (with the exception
of an HRA and a gynecologic exam if female) plus a saliva test. Participants will receive
the HPV vaccine or placebo as an injection into their upper arm or thigh on Day 0 and Weeks
8 and 24. Study staff will call participants 2 to 3 days after each vaccination for
follow-up monitoring. Additional study visits and procedures will occur at Week 28, Week 52,
and every 26 weeks thereafter for at least 3 years and for a maximum of 4 years after the
last participant is enrolled in the study. Female participants will also have a gynecologic
exam at screening, Week 52, and every 52 weeks thereafter; a pregnancy test at screening,
baseline, Week 8, Week 24, and as indicated; and self-collected vaginal swabs at screening,
entry, Week 28, Week 52, and every 26 weeks thereafter. Peripheral blood mononuclear cells
(PBMCs) will be collected from some participants at entry, Week 28, and study exit.


Inclusion Criteria:



- HIV-1 infection, documented by any licensed rapid HIV test or HIV enzyme or
chemiluminescence immunoassay (E/CIA) test kit at any time prior to study entry and
confirmed by a licensed Western blot or a second antibody test by a method other than
the initial rapid HIV and/or E/CIA, or by HIV-1 antigen, plasma HIV-1 RNA viral load.
More information on this criterion can be found in the protocol.

- Laboratory values obtained within 45 days prior to entry by any U.S. laboratory that
has a Clinical Laboratory Improvement Amendment (CLIA) certification or its
equivalent, or at any network-approved non-U.S. laboratory that operates in
accordance with Good Clinical Practices and participates in appropriate external
quality assurance programs:

1. Absolute neutrophil count (ANC) greater than 750 cells/mm^3

2. Hemoglobin greater than or equal to 9.0 g/dL

3. Platelet count greater than or equal to 75,000/mm^3

4. Serum creatinine less than or equal to three times the upper limit of normal
(ULN)

5. Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase
[SGOT]) and alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase
[SGPT]) less than or equal to five times the ULN

6. Total or conjugated (direct) bilirubin less than or equal to 2.5 times the ULN

- For men, receptive anal sex (defined as receptive penile-anal sex or receptive
oral-anal sex with another man) within 1 year prior to entry

- Anal cytology result from specimen obtained within 45 days prior to entry

- HRA performed within 45 days prior to entry by a certified HRA provider with no
evidence of invasive or microinvasive anal cancer by anal biopsy or by visual
inspection if no biopsy was obtained. Note: refer to protocol for more information
about HRA certification process.

- For women, gynecologic examination (including screening for cervical disease by
exfoliative cytology with or without colposcopy) within 45 days prior to entry.

- For women of reproductive potential, a negative serum or urine pregnancy test within
45 days prior to study entry by any U.S. laboratory that has a CLIA certification or
its equivalent, or at any network-approved non-U.S. laboratory that operates in
accordance with Good Clinical Practices and participates in appropriate external
quality assurance programs. More information on this criterion can be found in the
protocol.

- Confirmation of the availability of the anal swab, vaginal swab (women only) and
Scope oral rinse specimens for HPV DNA PCR obtained at screening. The site must
confirm that these samples have been entered into the Laboratory Data Management
System (LDMS).

- Ability and willingness of participant or legal representative to provide informed
consent

Exclusion Criteria:

- History or current biopsy diagnosis of invasive or microinvasive cancer, i.e.:

- For all participants: anal or oropharyngeal cancer

- For men: penile cancer

- For women: cervical, vulvar, or vaginal cancer

- More information on this criterion can be found in the protocol.

- Anal, cervical, or vaginal cytological results suspicious for invasive carcinoma at
any point prior to entry

- Topical or surgical treatment for intra- or perianal intraepithelial neoplasia or
condyloma within 6 months prior to entry. More information on this criterion can be
found in the protocol.

- Prior receipt of one or more doses of an HPV vaccine

- Receipt of anticoagulants other than aspirin or nonsteroidal anti-inflammatory drugs
(NSAIDS) within 14 days prior to entry

- Known allergy/sensitivity or any hypersensitivity to yeast or any of the components
of the study product or its formulation. More information on this criterion can be
found in the protocol.

- Active drug or alcohol use or dependence or other condition that, in the opinion of
the site investigator, would interfere with adherence to study requirements

- Serious illness requiring systemic treatment and/or hospitalization within 21 days
prior to entry

- Hemophilia or other bleeding diatheses

- Use of any systemic antineoplastic or immunomodulatory treatment, systemic
corticosteroids other than inhaled corticosteroids or prednisone less than or equal
to 10 mg (or equivalent), investigational vaccines, interleukins, interferons, growth
factors, or intravenous immunoglobulin (IVIG) within 45 days prior to study entry.
NOTE: Routine standard-of-care vaccines (including hepatitis A, hepatitis B,
influenza, pneumococcal, and tetanus vaccines) are not exclusionary.

- Expected treatment of hepatitis B or hepatitis C virus with immunomodulatory agents
in the 7 months after entry

- Breastfeeding

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Prevention

Outcome Measure:

Time to the first new persistent infection of HPV 6, 11, 16, or 18

Outcome Time Frame:

Measured through participant's last study visit, which will occur 3 to 4 years after the last participant is enrolled in the study

Safety Issue:

No

Principal Investigator

Timothy J. Wilkin, MD, MPH

Investigator Role:

Study Chair

Investigator Affiliation:

Cornell Clinical Research Site

Authority:

United States: Food and Drug Administration

Study ID:

A5298

NCT ID:

NCT01461096

Start Date:

March 2012

Completion Date:

Related Keywords:

  • HIV Infections
  • HIV Infections
  • Acquired Immunodeficiency Syndrome
  • Papillomavirus Infections

Name

Location

UCLA CARE Center CRSLos Angeles, California  90095
Stanford CRSPalo Alto, California  94305
Ucsd, Avrc CrsSan Diego, California  
Ucsf Aids CrsSan Francisco, California  
University of Colorado Hospital CRSAurora, Colorado  80262
Northwestern University CRSChicago, Illinois  60611
Rush Univ. Med. Ctr. ACTG CRSChicago, Illinois  60612
Johns Hopkins Adult AIDS CRSBaltimore, Maryland  21287
Massachusetts General Hospital ACTG CRSBoston, Massachusetts  02114
Beth Israel Deaconess Med. Ctr., ACTG CRSBoston, Massachusetts  02215
Bmc Actg CrsBoston, Massachusetts  02118
Washington U CRSSt. Louis, Missouri  
NY Univ. HIV/AIDS CRSNew York, New York  10016
Univ. of Rochester ACTG CRSRochester, New York  14642
Unc Aids CrsChapel Hill, North Carolina  27599
Univ. of Cincinnati CRSCincinnati, Ohio  45267
MetroHealth CRSCleveland, Ohio  
Hosp. of the Univ. of Pennsylvania CRSPhiladelphia, Pennsylvania  19104
Pitt CRSPittsburgh, Pennsylvania  15213
HIV Prevention & Treatment CRSNew York, New York  10032
The Ponce de Leon Ctr. CRSAtlanta, Georgia  30308
AIDS Care CRSRochester, New York  14607
Denver Public Health CRSDenver, Colorado  80204
Cornell CRSNew York, New York  10011
The Miriam Hosp. ACTG CRSProvidence, Rhode Island  02906
Houston AIDS Research Team CRSHouston, Texas  77030
New Jersey Medical School- Adult Clinical Research Ctr. CRSNewark, New Jersey  07103