- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02515240
Immune Response to Pneumococcal Vaccination in HIV Infected Individuals
Study Overview
Detailed Description
All potential study candidates will be asked to fill out a questionnaire concerning their medical history and medications. This survey will determine eligibility. If eligible, as part of the experimental protocol the HIV positive participants will agree to be randomized to immediate vs. delayed pneumococcal immunization and 3 blood draws around the time of immunization. The HIV negative control population will agree to immunization with pneumococcal polysaccharide vaccine (PPV), not standard of care for this population, and 3 blood draws around the time of immunization. The investigators will study the effect of pneumococcal vaccination in HIV positive adults. At the present time it is recommended that all HIV positive individuals receive the pneumococcal vaccine at the time of diagnosis with those with cluster of differentiation (CD4) count <200 to be vaccinated either immediately or alternatively, treated with highly active antiretroviral therapy (HAART) for 6 months followed by PPV. All patients are recommended to be re-vaccinated at 5 years. This is the standard of care. It is however unclear how the HIV positive patients respond to PPV. In the 1st part of the study, Part I, newly diagnosed HIV positive individuals will be recruited. As standard of care, these individuals will receive the pneumococcal vaccine regardless of their participation in this study. Those that agree to participate in the study will be grouped according to their CD4 count: >500, 200-500 or <200. Those with a CD4 count <200 will be randomly assigned to receive the vaccine immediately or to receive HAART for 6 months prior to vaccination, this is in accordance with the present recommendations, either immediate vaccination or giving HAART for 6 months prior to vaccination is considered acceptable.. Thus ALL HIV positive individuals will receive the vaccine as presently recommended. The HIV positive volunteers agree to (experimental part of the protocol):
- Be randomized to either immediate vaccination vs. 6 months after start of HAART if the CD4 count is <200
- Donate blood specimens at 3 different times: day 0, day of vaccination: 2 mL, at day 7, 40 mL and at day 28-42 a one time sample of 2 mL.
- Have their blood samples subjected to antibody analysis (concentration and functional activity) and antibody gene usage analysis There will be 4 HIV positive groups in this part of the study: CD4>500, CD4 200-500, CD4 < 200 immediate vaccination and CD4 <200, delayed vaccination.
There will be 19 individuals per group. The HIV negative controls in Part I of the study (n=19) who agree to participate will also be vaccinated with the pneumococcal vaccine. This is NOT a vaccine recommended for healthy adults but is NOT contra-indicated.
Thus as part of the experimental procedure for these individuals they will:
- Receive the FDA approved pneumococcal vaccine
- Blood samples will be obtained at day 0: 2 mL, day 7 40 mL and day 28-42, one time sample of 2 mL.
- Blood samples will be analyzed for antibody concentration, functional activity and gene family usage.
In summary, we will study a total of 5 groups in Part I:
Group 1: HIV positive CD4>500 Group 2: HIV positive CD4 200-500 Group 3: HIV positive CD4 < 200 immediate vaccination Group 4: HIV positive CD4<200 delayed (6 months) vaccination Group 5: HIV negative In part II of the study the investigators will evaluate the effect of a second pneumococcal vaccination, which is presently recommended, in HIV positive individuals, to be received 5 years after the first vaccination. Again, only those HIV positive individuals who are due for their second pneumovax will be asked to participate. They will be grouped according to their CD4 counts as CD4 >500 or CD4 200-500. Thus ALL HIV positive individuals will receive the vaccine as recommended.
The HIV positive volunteers solely agree to;
- Donate blood specimens at 3 different occasions: day 0, day of vaccination: 2 mL, at day 7, 40 mL and at day 28-42 a one time sample of 2 mL.
- Have their blood samples subjected to antibody analysis (concentration and functional activity) and antibody gene usage analysis There will be 2 HIV positive groups: CD4>500 and CD4 count 200-500. There will be 19 individuals per group.
The HIV negative controls in Part II of the study who agree to participate will be recruited from the population of individuals previously vaccinated with pneumovax. They will also be vaccinated for the second time with the pneumococcal vaccine, 5 years after the first vaccination. This is NOT a vaccine recommended for healthy adults but is NOT contra-indicated. Thus as part of the experimental procedure for these individuals they will:
- Receive the FDA approved pneumococcal vaccine
- Blood samples will be obtained at day 0: 2 mL, day 7 40 mL and day 28-42 one time sample of 2 mL.
- Blood samples will be analyzed for antibody concentration, functional activity and gene family usage.
In summary, we will study 3 groups in Part II of the study Group 6: HIV positive CD4>500, 2nd PPV Group 7: HIV positive CD4 200-500, 2nd PPV Group 8: HIV negative, 2nd PPV.
Study Type
Enrollment (Actual)
Phase
- Early Phase 1
Contacts and Locations
Study Locations
-
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Ohio
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Toledo, Ohio, United States, 43614
- The University of Toledo-Health Science Campus
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- HIV negative:
- never immunized with PPV23
- HIV positive:
- need for PPV23 per standard of care
Exclusion Criteria:
- steroid use
- other immunosuppressive agents;
- pregnancy
- incapable of completing consent form
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: healthy controls
healthy individuals, HIV negative, 19-50 yrs if age, immunized with one shot of PPV23 vaccine.
|
23 valent pneumococcal polysaccharide vaccine in Healthy adults.
Other Names:
|
Active Comparator: newly diagnosed HIV >200
Newly diagnosed HIV positive patients with CD4 count >200, immunized with one shot of PPV23 vaccine.
|
23 valent pneumococcal polysaccharide vaccine in Healthy adults.
Other Names:
|
Active Comparator: newly diagnosed HIV <200
Newly diagnosed HIVpositive patients with CD4 count <200, immediately immunized with one shot of PPV23 vaccine.
|
23 valent pneumococcal polysaccharide vaccine in Healthy adults.
Other Names:
|
Active Comparator: newly diagnosed HIV <200 delayed
Newly diagnosed HIV positive patients with CD4 count <200 delayed immunization with one shot of PPV23 vaccine, treated for 6-12 months with Highly Active Anti-Retroviral Therapy (HAART) first.
|
23 valent pneumococcal polysaccharide vaccine in Healthy adults.
Other Names:
|
Active Comparator: HAART experienced HIV>200
HIV positive, on HAART treatment for 5 years, nadir CD4 count <200, but at present CD4 count is >200, immunized with one shot of PPV23 vaccine.
|
23 valent pneumococcal polysaccharide vaccine in Healthy adults.
Other Names:
|
Active Comparator: HAART experienced HIV<200
HIVpositive, on HAART treatment for 5 years, nadir CD4 count <200, and at present CD4 count is <200, immunized with one shot of PPV23 vaccine.
|
23 valent pneumococcal polysaccharide vaccine in Healthy adults.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Antibody activity and response by opsonophagocytic assay (OPT) and ELISA (ug/ml)
Time Frame: Day 0 and day 30 of vaccination
|
Day 0 and day 30 of vaccination
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Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Polysaccharide-specific B cell phenotype: percentage naive or memory B cell distribution flow cytometry
Time Frame: Day 0 and Day7 of vaccination
|
Day 0 and Day7 of vaccination
|
Flow cytometry : percentage cells expressing tumor necrosis factor receptors on surface
Time Frame: Day 0 and Day7 of vaccination
|
Day 0 and Day7 of vaccination
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Julie MA Westerink, MD, University of Toledo-HSC
Publications and helpful links
General Publications
- Ballet JJ, Sulcebe G, Couderc LJ, Danon F, Rabian C, Lathrop M, Clauvel JP, Seligmann M. Impaired anti-pneumococcal antibody response in patients with AIDS-related persistent generalized lymphadenopathy. Clin Exp Immunol. 1987 Jun;68(3):479-87.
- Janoff EN, Douglas JM Jr, Gabriel M, Blaser MJ, Davidson AJ, Cohn DL, Judson FN. Class-specific antibody response to pneumococcal capsular polysaccharides in men infected with human immunodeficiency virus type 1. J Infect Dis. 1988 Nov;158(5):983-90. doi: 10.1093/infdis/158.5.983.
- Klein RS, Selwyn PA, Maude D, Pollard C, Freeman K, Schiffman G. Response to pneumococcal vaccine among asymptomatic heterosexual partners of persons with AIDS and intravenous drug users infected with human immunodeficiency virus. J Infect Dis. 1989 Nov;160(5):826-31. doi: 10.1093/infdis/160.5.826.
- Kroon FP, van Dissel JT, Ravensbergen E, Nibbering PH, van Furth R. Enhanced antibody response to pneumococcal polysaccharide vaccine after prior immunization with conjugate pneumococcal vaccine in HIV-infected adults. Vaccine. 2000 Nov 22;19(7-8):886-94. doi: 10.1016/s0264-410x(00)00232-2.
- Rodriguez-Barradas MC, Musher DM, Lahart C, Lacke C, Groover J, Watson D, Baughn R, Cate T, Crofoot G. Antibody to capsular polysaccharides of Streptococcus pneumoniae after vaccination of human immunodeficiency virus-infected subjects with 23-valent pneumococcal vaccine. J Infect Dis. 1992 Mar;165(3):553-6. doi: 10.1093/infdis/165.3.553.
- Loeliger AE, Rijkers GT, Aerts P, Been-Tiktak A, Hoepelman AI, van Dijk H, Borleffs JC. Deficient antipneumococcal polysaccharide responses in HIV-seropositive patients. FEMS Immunol Med Microbiol. 1995 Sep;12(1):33-41. doi: 10.1111/j.1574-695X.1995.tb00171.x.
- Ochs HD, Junker AK, Collier AC, Virant FS, Handsfield HH, Wedgwood RJ. Abnormal antibody responses in patients with persistent generalized lymphadenopathy. J Clin Immunol. 1988 Jan;8(1):57-63. doi: 10.1007/BF00915157.
- Opravil M, Fierz W, Matter L, Blaser J, Luthy R. Poor antibody response after tetanus and pneumococcal vaccination in immunocompromised, HIV-infected patients. Clin Exp Immunol. 1991 May;84(2):185-9. doi: 10.1111/j.1365-2249.1991.tb08146.x.
- Ragni MV, Ruben FL, Winkelstein A, Spero JA, Bontempo FA, Lewis JH. Antibody responses to immunization of patients with hemophilia with and without evidence of human immunodeficiency virus (human T-lymphotropic virus type III) infection. J Lab Clin Med. 1987 May;109(5):545-9.
- Unsworth DJ, Rowen D, Carne C, Sonnex C, Baglin T, Brown DL. Defective IgG2 response to Pneumovax in HIV seropositive patients. Genitourin Med. 1993 Oct;69(5):373-6. doi: 10.1136/sti.69.5.373.
- Berberian L, Goodglick L, Kipps TJ, Braun J. Immunoglobulin VH3 gene products: natural ligands for HIV gp120. Science. 1993 Sep 17;261(5128):1588-91. doi: 10.1126/science.7690497.
- Berberian L, Shukla J, Jefferis R, Braun J. Effects of HIV infection on VH3 (D12 idiotope) B cells in vivo. J Acquir Immune Defic Syndr (1988). 1994 Jul;7(7):641-6.
- Karray S, Zouali M. Identification of the B cell superantigen-binding site of HIV-1 gp120. Proc Natl Acad Sci U S A. 1997 Feb 18;94(4):1356-60. doi: 10.1073/pnas.94.4.1356.
- Townsley-Fuchs J, Neshat MS, Margolin DH, Braun J, Goodglick L. HIV-1 gp120: a novel viral B cell superantigen. Int Rev Immunol. 1997;14(4):325-38. doi: 10.3109/08830189709116523.
- Muller S, Kohler H. B cell superantigens in HIV-1 infection. Int Rev Immunol. 1997;14(4):339-49. doi: 10.3109/08830189709116524.
- Chang Q, Abadi J, Alpert P, Pirofski L. A pneumococcal capsular polysaccharide vaccine induces a repertoire shift with increased VH3 expression in peripheral B cells from human immunodeficiency virus (HIV)-uninfected but not HIV-infected persons. J Infect Dis. 2000 Apr;181(4):1313-21. doi: 10.1086/315405. Epub 2000 Apr 13.
- Iyer AS, Khaskhely NM, Leggat DJ, Ohtola JA, Saul-McBeth JL, Khuder SA, Westerink MA. Inflammatory Markers and Immune Response to Pneumococcal Vaccination in HIV-Positive and -Negative Adults. PLoS One. 2016 Mar 1;11(3):e0150261. doi: 10.1371/journal.pone.0150261. eCollection 2016.
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- HIV PPV23
- 5R01AI081558 (U.S. NIH Grant/Contract)
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