Vaccine Therapy in Preventing Human Papillomavirus Infection in Young HIV-Positive Male Patients Who Have Sex With Males

AMC-072: Protective Effect of Quadrivalent Vaccine in Young HIV-Positive Males Who Have Sex With Males

RATIONALE: Vaccines made from a gene-modified virus may help the body build an effective immune response to prevent viral infection.

PURPOSE: This phase II trial is studying how well vaccine therapy works in preventing human papillomavirus (HPV) infection in young HIV-positive male patients who have sex with males.

Study Overview

• Status: Completed
• Conditions: Precancerous Condition; Anal Cancer; Penile Cancer; Nonneoplastic Condition
• Intervention / Treatment: Other: laboratory biomarker analysis; Biological: quadrivalent human papillomavirus (types 6, 11, 16, 18) recombinant vaccine

Detailed Description

OBJECTIVES:

Primary

• To determine the protective effect of the HPV-6, -11, -16, -18 vaccine in preventing penile/scrotal condyloma and HPV-6, -11, -16, -18- associated perianal/anal disease in HIV-positive males who have sex with males (MSM) age 13-26 years by comparing the incidence of these lesions among those naïve to the relevant HPV type(s) at baseline to those who are not naïve at baseline.
• To determine the protective effect of the HPV-6, -11, -16, -18 vaccine in preventing persistent anogenital infection with HPV-6, -11, -16, or 18 in HIV-positive MSM age 13-26 years by comparing the incidence of persistent infection among those naïve to the relevant HPV type(s) at baseline to those who are not naïve at baseline.
• To determine the protective effect of the HPV-6, -11, -16, -18 vaccine in preventing anogenital lesions associated with HPV 6,-11,-16, -18 and persistent infection with these types, in HIV-positive MSM age 13-26 years by comparing the incidence of lesions and persistent infection among those naïve to the relevant types at baseline to incident lesions and infection among MSM naïve to these HPV types who participated in the Merck 020 protocol and who received placebo as part of the protocol.

Secondary

• To define the safety of the HPV-6, -11, -16, -18 vaccine in HIV-positive MSM age 13-26 years.
• To evaluate the levels and persistence of HPV 6, 11, 16 and 18 Ab titers after the vaccination series among subjects who are seropositive and seronegative at baseline.
• To examine whether the protective effect and antibody titers vary as a function of the following at the time of initial vaccination: subject age, HAART treatment status, HIV viral load, CD4 + T-cell count, and nadir CD4 level.

Tertiary

• To quantify anogenital HPV DNA viral load prior to and after receipt of the quadrivalent HPV vaccine.
• To identify and quantify HPV types in the oral cavity of HIV-positive MSM prior to and after receipt of the quadrivalent HPV vaccine.
• To identify HPV strain variants among HIV-positive participants prior to and after receipt of the quadrivalent HPV vaccine.
• Assess the prevalence and incidence of urinary and gonorrhea and Chlamydia trachomatis infection at baseline and their relationship with prevalent and incident anogenital HPV infection and anal condyloma or AIN.
• To characterize young men's risk perceptions, sexual behaviors, and STI diagnosis after HPV vaccination.

OUTLINE: This is a multicenter study.

Patients receive quadrivalent human papillomavirus (types 6, 11, 16, and 18) recombinant vaccine intramuscularly on day 1 and in weeks 8 and 24.

Blood and tissue samples may be collected periodically for laboratory studies.

After completion of study treatment, patients are followed up for 2 years.

• Study Type: Interventional
• Enrollment (Actual): 149
• Phase: Phase 2

Contacts and Locations

Study Locations

• Puerto Rico
  • San Juan, Puerto Rico, 00927
    • University of Puerto Rico Comprehensive Cancer Center
• United States
  • California
    • La Jolla, California, United States, 92093
      • Moores UCSD Cancer Center
    • Los Angeles, California, United States, 90027-0700
      • Childrens Hospital Los Angeles
    • Los Angeles, California, United States, 90024
      • UCLA Clinical AIDS Research and Education (CARE) Center
    • San Francisco, California, United States, 94115
      • UCSF Helen Diller Family Comprehensive Cancer Center
  • Colorado
    • Aurora, Colorado, United States, 80045
      • University of Colorado Cancer Center at UC Health Sciences Center
  • Illinois
    • Chicago, Illinois, United States, 60612-9985
      • John H. Stroger, Jr. Hospital of Cook County
    • Chicago, Illinois, United States, 60612
      • Ruth M. Rothstein Core Center at Cook County Hospital
  • Massachusetts
    • Boston, Massachusetts, United States, 02118
      • Boston University Cancer Research Center
    • Boston, Massachusetts, United States, 02115
      • Fenway Community Health
  • Missouri
    • Saint Louis, Missouri, United States, 63110
      • Washington University School of Medicine
  • New York
    • Bronx, New York, United States, 10467
      • Montefiore Medical Center
    • Bronx, New York, United States, 10461
      • Montefiore Medical Center
    • New York, New York, United States, 10010
      • Laser Surgery Care
  • North Carolina
    • Winston-Salem, North Carolina, United States, 27157
      • Wake Forest University Health Sciences
  • Tennessee
    • Memphis, Tennessee, United States, 38105
      • St. Jude's Children's Research Hospital
  • Texas
    • Houston, Texas, United States, 77030
      • Dan L. Duncan Cancer Center at Baylor College of Medicine
    • Houston, Texas, United States, 77009
      • Thomas Street Health Center
  • Washington
    • Seattle, Washington, United States, 98101
      • Virginia Mason Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 13 years to 26 years (Child, Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Male

Description

DISEASE CHARACTERISTICS:

• Men with a history of at least one male sexual partner

  • "Men" is defined as those documented "male" at birth (including male-to-female transgendered persons)

• HIV-1 infection as documented by any federally approved, licensed HIV test performed in conjunction with screening (ELISA, western blot, or other approved test)

  • Alternatively, this documentation may include a record that another physician has documented that the patient has HIV based on prior ELISA and western blot, or other approved diagnostic tests

• Meets one of the following sets of criteria:

  • Patients receiving antiretroviral therapy:

    • Receipt of antiretroviral therapy for at least 3 months prior to entry
    • No change in antiretroviral therapy within 30 days prior to entry

  • Patients not receiving antiretroviral therapy:

    • CD4-cell count ≥ 350 cells/mm³ within 90 days prior to study entry
    • No plans to start antiretroviral therapy prior to Week 28

• Normal anal cytological result, LSIL/condyloma, or ASCUS result within 90 days prior to entry, and no HGAIN on biopsy

  • No current or history of anal or peri-anal carcinoma
  • No anal cytological result of HSIL, atypical squamous cells suggestive of HSIL (ASC-H), or suggestive of invasive carcinoma at screening; or history of these results
• No presence of penile or scrotal condyloma, LGAIN (condyloma or AIN 1), HGAIN (e.g., AIN 2 or 3, or perianal intraepithelial neoplasia grade 2 or 3), or invasive carcinoma at pre-entry on biopsy
• No history of HGAIN

PATIENT CHARACTERISTICS:

• Karnofsky performance score ≥ 70 within 45 days prior to entry
• Absolute neutrophil count (ANC) > 750 cells/mm^3
• Hemoglobin ≥ 9.0 g/dL
• Platelet count ≥ 100,000/mm^3
• AST (SGOT), ALT (SGPT) ≤ 3 times upper limit of normal (ULN)
• Total or conjugated (direct) bilirubin ≤ 2.5 times ULN within 45 days before study entry, with the exception of isolated hyperbilirubinemia that is considered due to atazanavir
• Calculated creatinine clearance ≥ 60 mL/min
• No hemophilia
• No active drug or alcohol use or dependence that, in the opinion of the site Investigator, would interfere with adherence to study requirements
• No serious illness requiring systemic treatment and/or hospitalization within 45 days prior to entry
• No serious medical or psychiatric illness that, in the opinion of the site Investigator, will interfere with the ability of the subject to give informed consent or adhere to the protocol
• No allergy to yeast or any of the components of Gardasil

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• No prior splenectomy
• No prior receipt of Gardasil or other HPV vaccine
• No use of any systemic antineoplastic or immunomodulatory treatment, systemic corticosteroids for greater than 14 days, investigational vaccines, interleukins, interferons, growth factors, or IVIG within 45 days prior to study entry

• No expected use of any systemic antineoplastic or immunomodulatory treatment, systemic corticosteroids used for greater than 14 days, investigational vaccines, interleukins, interferons, growth factors, or IVIG during study followup

  • No patients with hepatitis C who expect to initiate treatment for hepatitis C (e.g., interferons) during this trial
• Not currently receiving anticoagulation therapy other than acetylsalicylic acid

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Vaccination; Gardasil (quadrivalent HPV types 6, 11, 16, 18) vaccination at weeks 0, 8, 24.	Other: laboratory biomarker analysis; Biological: quadrivalent human papillomavirus (types 6, 11, 16, 18) recombinant vaccine

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence of AIN or Anal/Perianal Condyloma Associated With HPV 6 DNA	Incident events are defined as having AIN (e.g., AIN or anal/perianal condyloma) with HPV 6 positive DNA in participants without HPV-6 related AIN at baseline.	Post Month 7 through Month 24
Incidence of AIN or Anal/Perianal Condyloma Associated With HPV 11 DNA	Incident events are defined as having AIN (e.g., AIN or anal/perianal condyloma) with HPV 11 positive DNA in participants without HPV-11 related AIN at baseline.	Post Month 7 through Month 24
Incidence of AIN or Anal/Perianal Condyloma Associated With HPV 16 DNA	Incident events are defined as having AIN (e.g., AIN or anal/perianal condyloma) with HPV 16 positive DNA in participants without HPV-16 related AIN at baseline.	Post Month 7 through Month 24
Incidence of AIN or Anal/Perianal Condyloma Associated With HPV 18 DNA	Incident events are defined as having AIN (e.g., AIN or anal/perianal condyloma) with HPV 18 positive DNA in participants without HPV-18 related AIN at baseline.	Post Month 7 through Month 24
Incidence of Persistent Anogenital Infection With HPV 6 DNA	Incident events are defined as having HPV 6 positive PCR results at 2 or more consecutive visits in those who were DNA negative for HPV 6. Persistence was defined based on being persistent in the same anatomical site.	Post Month 7 through Month 24
Incidence of Persistent Anogenital Infection With HPV 11 DNA	Incident events are defined as having positive PCR results with HPV 11 at 2 or more consecutive visits in those who were DNA negative for HPV 11 at baseline. Persistence was defined based on being persistent in the same anatomical site.	Post Month 7 through Month 24
Incidence of Persistent Anogenital Infection With HPV 16 DNA	Incident events are defined as having positive PCR results with HPV 16 at 2 or more consecutive visits in those who were DNA negative for HPV 16 at baseline. Persistence was defined based on being persistent in the same anatomical site.	Post Month 7 through Month 24
Incidence of Persistent Anogenital Infection With HPV 18 DNA	Incident events are defined as having positive PCR results with HPV 18 at 2 or more consecutive visits in those who were DNA negative for HPV 18. Persistence was defined based on being persistent in the same anatomical site.	Post Month 7 through Month 24
Incidence of HGAIN Associated With HPV 6	Incident events are defined as having HGAIN (e.g., AIN 2 or 3, or perianal intraepithelial neoplasia grade 2 or 3) with HPV 6 positive DNA in participants without HPV 6 related HGAIN at baseline.	Post month 7 through month 24
Incidence of HGAIN Associated With HPV 11	Incident events are defined as having HGAIN (e.g., AIN 2 or 3, or perianal intraepithelial neoplasia grade 2 or 3) with HPV 11 positive DNA in participants without HPV 11 related HGAIN at baseline.	Post month 7 through month 24
Incidence of HGAIN Associated With HPV 16	Incident events are defined as having HGAIN (e.g., AIN 2 or 3, or perianal intraepithelial neoplasia grade 2 or 3) with HPV 16 positive DNA in participants without HPV 16 related HGAIN at baseline.	Post month 7 through month 24
Incidence of HGAIN Associated With HPV 18	Incident events are defined as having HGAIN (e.g., AIN 2 or 3, or perianal intraepithelial neoplasia grade 2 or 3) with HPV 18 positive DNA in participants without HPV 18 related HGAIN at baseline.	Post month 7 through month 24
Incidence of Penile/Scrotal Condyloma in HPV 6 Naive and Prior Exposed Participants	Incident events are defined as having penile/scrotal warts reported clinically in participants penile/scrotal condyloma at baseline.	Post month 7 through month 24
Incidence of Penile/Scrotal Condyloma in HPV 11 Naive and Prior Exposed Participants	Incident events are defined as having penile/scrotal warts reported clinically in participants penile/scrotal condyloma at baseline.	Post month 7 through month 24
Incidence of Penile/Scrotal Condyloma in HPV 16 Naive and Prior Exposed Participants	Incident events are defined as having penile/scrotal warts reported clinically in participants penile/scrotal condyloma at baseline.	Post month 7 through month 24
Incidence of Penile/Scrotal Condyloma in HPV 18 Naive and Prior Exposed Participants	Incident events are defined as having penile/scrotal warts reported clinically in participants penile/scrotal condyloma at baseline.	Post month 7 through month 24

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Occurrence of Grade ≥ 3 Adverse Events (AEs) That Were Possibly, Probably, or Definitely Related to the Vaccine	Number of participants who experienced grade 3 and higher AEs that were possibly, probably or definitely related to the vaccine.	Through Month 24
Geometric Mean Titers for HPV 6	Geometric mean concentration of antibodies for HPV 6 at each visit	Baseline through month 24
Geometric Mean Titers for HPV 11	Geometric mean concentration of antibodies for HPV 11 at each visit	Baseline through month 24
Geometric Mean Titers for HPV 16	Geometric mean concentration of antibodies for HPV 16 at each visit	Baseline through 24 months
Geometric Mean Titers for HPV 18	Geometric mean concentration of antibodies for HPV 18 at each visit	Baseline through 24 months
Geometric Mean Titers for HPV 6 According to Participant Age, HIV Viral Load, CD4+ T Cell Count, and Nadir CD4 Level	Geometric mean concentration of antibodies for HPV 6 at 7 and 24 months	at 7 and 24 Months
Geometric Mean Titers for HPV 11 According to Participant Age, HIV Viral Load, CD4+ T Cell Count, and Nadir CD4 Level	Geometric mean concentration of antibodies for HPV 11 at 7 and 24 months	at 7 and 24 Months
Geometric Mean Titers for HPV 16 According to Participant Age, HIV Viral Load, CD4+ T Cell Count, and Nadir CD4 Level	Geometric mean concentration of antibodies for HPV 16 at 7 and 24 months	at 7 and 24 Months
Geometric Mean Titers for HPV 18 According to Participant Age, HIV Viral Load, CD4+ T Cell Count, and Nadir CD4 Level	Geometric mean concentration of antibodies for HPV 18 at 7 and 24 months	at 7 and 24 Months

Collaborators and Investigators

• Sponsor: AIDS Malignancy Consortium
• Collaborators: National Cancer Institute (NCI); Merck Sharp & Dohme LLC; University of Arkansas; The Emmes Company, LLC; AIDS and Cancer Specimen Resource

Publications and helpful links

General Publications

• Kahn JA, Belzer M, Chi X, Lee J, Gaur AH, Mayer K, Martinez J, Futterman DC, Stier EA, Paul ME, Chiao EY, Reirden D, Goldstone SE, Ortiz Martinez AP, Cachay ER, Barroso LF, Da Costa M, Wilson CM, Palefsky JM; AIDS Malignancy Consortium and Adolescent Medicine Trials Network for HIV/AIDS Interventions. Pre-vaccination prevalence of anogenital and oral human papillomavirus in young HIV-infected men who have sex with men. Papillomavirus Res. 2019 Jun;7:52-61. doi: 10.1016/j.pvr.2019.01.002. Epub 2019 Jan 15.

Study record dates

Study Major Dates

• Study Start (Actual): June 28, 2011
• Primary Completion (Actual): December 12, 2017
• Study Completion (Actual): December 12, 2017

Study Registration Dates

• First Submitted: September 24, 2010
• First Submitted That Met QC Criteria: September 24, 2010
• First Posted (Estimate): September 27, 2010

Study Record Updates

• Last Update Posted (Actual): August 11, 2020
• Last Update Submitted That Met QC Criteria: August 6, 2020
• Last Verified: August 1, 2020

More Information

Terms related to this study

• Keywords: HIV infection; human papilloma virus infection; anal cancer; penile cancer
• Additional Relevant MeSH Terms: Digestive System Diseases; Pathologic Processes; Neoplasms; Urogenital Neoplasms; Neoplasms by Site; Gastrointestinal Neoplasms; Digestive System Neoplasms; Gastrointestinal Diseases; Genital Neoplasms, Male; Intestinal Diseases; Intestinal Neoplasms; Rectal Diseases; Colorectal Neoplasms; Rectal Neoplasms; Anus Diseases; Penile Diseases; Disease; Precancerous Conditions; Anus Neoplasms; Penile Neoplasms
• Other Study ID Numbers: AMC-072 (Other Identifier: AMC); U01CA121947 (U.S. NIH Grant/Contract); CDR0000685816 (Other Identifier: NCI)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No