1
|
Kim JH, Excler JL, Michael NL. Lessons from the RV144 Thai phase III HIV-1 vaccine trial and the search for correlates of protection. Annu Rev Med 2014; 66:423-37. [PMID: 25341006 DOI: 10.1146/annurev-med-052912-123749] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
RV144 remains the only HIV-1 vaccine trial to demonstrate efficacy against HIV-1 acquisition. The prespecified analysis of immune correlates of risk showed that antibodies directed against the V1V2 region of gp120, in particular the IgG1 and IgG3 subclass mediating antibody-dependent cell-mediated cytotoxicity, seem to play a predominant role in protection against HIV-1 acquisition and that plasma envelope (Env)-specific IgA antibodies were directly correlated with risk. RV144 and recent nonhuman primate challenge studies suggest that Env is essential, and perhaps sufficient, to induce protective antibody responses against mucosal HIV-1 acquisition. Follow-up clinical trials are ongoing to further dissect the immune responses elicited by the RV144 ALVAC-HIV and AIDSVAX® B/E regimen. The study of gp120 Env immunogens and immune correlates of risk has resulted in the development of improved antigens. Whether the RV144 immune correlates of risk will generalize to other populations vaccinated with similar immunogens with different modes and intensity of transmission remains to be demonstrated. Efficacy trials are now planned in heterosexual populations in southern Africa and men who have sex with men in Thailand.
Collapse
Affiliation(s)
- Jerome H Kim
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland 20910; ,
| | | | | |
Collapse
|
2
|
de Souza MS, Ratto-Kim S, Chuenarom W, Schuetz A, Chantakulkij S, Nuntapinit B, Valencia-Micolta A, Thelian D, Nitayaphan S, Pitisuttithum P, Paris RM, Kaewkungwal J, Michael NL, Rerks-Ngarm S, Mathieson B, Marovich M, Currier JR, Kim JH. The Thai phase III trial (RV144) vaccine regimen induces T cell responses that preferentially target epitopes within the V2 region of HIV-1 envelope. THE JOURNAL OF IMMUNOLOGY 2012; 188:5166-76. [PMID: 22529301 DOI: 10.4049/jimmunol.1102756] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The Thai HIV phase III prime/boost vaccine trial (RV144) using ALVAC-HIV (vCP1521) and AIDSVAX B/E was, to our knowledge, the first to demonstrate acquisition efficacy. Vaccine-induced, cell-mediated immune responses were assessed. T cell epitope mapping studies using IFN-γ ELISPOT was performed on PBMCs from HIV-1-uninfected vaccine (n = 61) and placebo (n = 10) recipients using HIV-1 Env peptides. Positive responses were measured in 25 (41%) vaccinees and were predominantly CD4(+) T cell-mediated. Responses were targeted within the HIV Env region, with 15 of 25 (60%) of vaccinees recognizing peptides derived from the V2 region of HIV-1 Env, which includes the α(4)β(7) integrin binding site. Intracellular cytokine staining confirmed that Env responses predominated (19 of 30; 63% of vaccine recipients) and were mediated by polyfunctional effector memory CD4(+) T cells, with the majority of responders producing both IL-2 and IFN-γ (12 of 19; 63%). HIV Env Ab titers were higher in subjects with IL-2 compared with those without IL-2-secreting HIV Env-specific effector memory T cells. Proliferation assays revealed that HIV Ag-specific T cells were CD4(+), with the majority (80%) expressing CD107a. HIV-specific T cell lines obtained from vaccine recipients confirmed V2 specificity, polyfunctionality, and functional cytolytic capacity. Although the RV144 T cell responses were modest in frequency compared with humoral immune responses, the CD4(+) T cell response was directed to HIV-1 Env and more particularly the V2 region.
Collapse
Affiliation(s)
- Mark S de Souza
- U.S. Military HIV Research Program/U.S. Army Medical Component, Armed Forces Research Institute of Medical Sciences, Bangkok 10400, Thailand.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Vaccari M, Poonam P, Franchini G. Phase III HIV vaccine trial in Thailand: a step toward a protective vaccine for HIV. Expert Rev Vaccines 2010; 9:997-1005. [PMID: 20822342 PMCID: PMC7337582 DOI: 10.1586/erv.10.104] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The large human efficacy trail in Thailand, RV144, was concluded in the summer of 2009. This is the first Phase III trial to show limited, but significant, efficacy in preventing HIV acquisition. This trial represents the first sign that a preventive vaccine for HIV may be feasible. The vaccine regimen tested in Thailand consisted of priming with a Canarypox vector carrying three synthetic HIV genes. The priming was followed by booster inoculations with two recombinant envelope proteins from HIV, clade B and E. The need to understand the role in protection from HIV acquisition of the new responses, induced by this vaccine combination, has brought together many researchers with the common goal of improving the development of a safe and effective vaccine for HIV.
Collapse
Affiliation(s)
- Monica Vaccari
- Animal Models and Retroviral Vaccine Section, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Poonam Poonam
- Animal Models and Retroviral Vaccine Section, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Genoveffa Franchini
- Animal Models and Retroviral Vaccine Section, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| |
Collapse
|
4
|
Rerks-Ngarm S, Pitisuttithum P, Nitayaphan S, Kaewkungwal J, Chiu J, Paris R, Premsri N, Namwat C, de Souza M, Adams E, Benenson M, Gurunathan S, Tartaglia J, McNeil JG, Francis DP, Stablein D, Birx DL, Chunsuttiwat S, Khamboonruang C, Thongcharoen P, Robb ML, Michael NL, Kunasol P, Kim JH. Vaccination with ALVAC and AIDSVAX to prevent HIV-1 infection in Thailand. N Engl J Med 2009; 361:2209-20. [PMID: 19843557 DOI: 10.1056/nejmoa0908492] [Citation(s) in RCA: 2340] [Impact Index Per Article: 156.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The development of a safe and effective vaccine against the human immunodeficiency virus type 1 (HIV-1) is critical to pandemic control. METHODS In a community-based, randomized, multicenter, double-blind, placebo-controlled efficacy trial, we evaluated four priming injections of a recombinant canarypox vector vaccine (ALVAC-HIV [vCP1521]) plus two booster injections of a recombinant glycoprotein 120 subunit vaccine (AIDSVAX B/E). The vaccine and placebo injections were administered to 16,402 healthy men and women between the ages of 18 and 30 years in Rayong and Chon Buri provinces in Thailand. The volunteers, primarily at heterosexual risk for HIV infection, were monitored for the coprimary end points: HIV-1 infection and early HIV-1 viremia, at the end of the 6-month vaccination series and every 6 months thereafter for 3 years. RESULTS In the intention-to-treat analysis involving 16,402 subjects, there was a trend toward the prevention of HIV-1 infection among the vaccine recipients, with a vaccine efficacy of 26.4% (95% confidence interval [CI], -4.0 to 47.9; P=0.08). In the per-protocol analysis involving 12,542 subjects, the vaccine efficacy was 26.2% (95% CI, -13.3 to 51.9; P=0.16). In the modified intention-to-treat analysis involving 16,395 subjects (with the exclusion of 7 subjects who were found to have had HIV-1 infection at baseline), the vaccine efficacy was 31.2% (95% CI, 1.1 to 52.1; P=0.04). Vaccination did not affect the degree of viremia or the CD4+ T-cell count in subjects in whom HIV-1 infection was subsequently diagnosed. CONCLUSIONS This ALVAC-HIV and AIDSVAX B/E vaccine regimen may reduce the risk of HIV infection in a community-based population with largely heterosexual risk. Vaccination did not affect the viral load or CD4+ count in subjects with HIV infection. Although the results show only a modest benefit, they offer insight for future research. (ClinicalTrials.gov number, NCT00223080.)
Collapse
|
5
|
Pialoux G, Quercia RP, Gahery H, Daniel N, Slama L, Girard PM, Bonnard P, Rozenbaum W, Schneider V, Salmon D, Guillet JG. Immunological responses and long-term treatment interruption after human immunodeficiency virus type 1 (HIV-1) lipopeptide immunization of HIV-1-infected patients: the LIPTHERA study. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2008; 15:562-8. [PMID: 18184824 PMCID: PMC2268255 DOI: 10.1128/cvi.00165-07] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Revised: 09/02/2007] [Accepted: 12/19/2007] [Indexed: 12/24/2022]
Abstract
We studied the time course of immunological and virological markers after highly active antiretroviral therapy (HAART) interruption in chronically human immunodeficiency virus type 1 (HIV-1)-infected patients immunized with an HIV lipopeptide preparation. In a prospective open pilot study, 24 HIV-1-infected HAART-treated patients with undetectable plasma viral loads (pVLs) and CD4(+) T-cell counts above 350/mm(3) were immunized at weeks 0, 3, and 6 with a candidate vaccine consisting of six HIV lipopeptides. At week 24, patients with pVLs of <1.7 log(10) copies/ml were invited to stop taking HAART. Antiretroviral therapy was resumed if the pVL rose above 4.47 log(10) copies/ml and/or if the CD4(+) cell count fell below 250/mm(3). Immunological and virologic parameters were studied before and after HAART interruption. The median baseline and nadir CD4(+) cell counts were 482 (interquartile range [IQR], 195 to 826) and 313 (IQR, 1 to 481)/mm(3), respectively. New specific CD8(+) cell responses to HIV-1 epitopes were detected after immunization in 13 (57%) of 23 assessable patients. Twenty-one patients were evaluated 96 weeks after HAART interruption. The median time to pVL rebound was 4 weeks (IQR, 2 to 6), and the median peak pVL was 4.26 (IQR, 3 to 5) log(10) copies/ml. Thirteen of these 21 patients resumed HAART a median of 60 weeks after immunization (IQR, 9.2 to 68.4 weeks), when the median pVL was 4.8 (IQR, 2.9 to 5.7) log(10) copies/ml and the median CD4(+) cell count was 551 (IQR, 156 to 778)/mm(3). Eight patients were still off therapy at 96 weeks, with a median pVL of 4 (IQR, 1.7 to 4.6) log(10) copies/ml and a median CD4(+) cell count of 412 (IQR, 299 to 832)/mm(3). No clinical disease progression had occurred. Despite the lack of a control arm, these findings warrant a randomized study of therapeutic vaccination with HIV lipopeptides followed by long-term HAART interruption in AIDS-free chronically infected patients.
Collapse
|
6
|
Abstract
Recently, there has been a renewed interest in therapeutic vaccination as an adjunct or alternative to current treatment options for HIV. The first immunotherapeutic trial relevant to this topic was published in 1983. Since then, several dozen therapeutic vaccine trials have been carried out. The results have consistently shown that although in vitro-measured HIV-specific immune responses were evident as a result of vaccination, clinical improvement has been seldom observed. The instances of apparent clinical benefit however, were invariably associated with the usage of vaccines that acted in accord with the principles of allo- or autoimmunization. The majority of these vaccines were derived from the blood of HIV carriers or a cell culture and therefore inherently contained host-cell antigens unrelated to HIV. These observations raise the issue of whether this clinically successful approach has been unduly neglected. Most commercial vaccines on the market today are made the old-fashioned way, but very little support or attention has been given to the development of such vaccines for AIDS therapy. The current strategy, biased toward vaccines which have shown little evidence of clinical efficacy, is shortsighted and needs to be revised.
Collapse
|
7
|
Abstract
The interruption of HIV transmission from mother to child is important. Prevention strategies, including antiretroviral agents administered to the mother and/or child, can successfully prevent such transmission. Avoidance of breastfeeding or the administration of antiretroviral agents to the mother while she continues breastfeeding is another strategy. Based on the successful model of hepatitis B prevention by treatment of the newborn, research protocols have been designed to prevent mother-to-child transmission of HIV by the administration of passive HIV-specific antibody preparations and HIV vaccines to the mother and/or child. A number of animal studies using active and passive products have shown efficacy in similar settings, providing hope that a similar strategy will work in humans. Clinical trials conducted through the US National Institutes of Health AIDS Clinical Trials Programs have focused on such an approach. This article summarizes the results of a number of these trials, including AVEG (AIDS Vaccine Evaluation Group) 104, a phase I study of active immunization of HIV-infected pregnant women with an HIV gp120 subunit vaccine, and PACTG (Pediatrics AIDS Clinical Trial Group) 185, a phase III efficacy trial of HIV immunoglobulin administered to HIV-infected pregnant women and their newborns. A number of HIV vaccine trials have been performed in HIV-exposed and -infected children. These include PACTG 218, a vaccine immunotherapy phase I trial of HIV subunit vaccines administered to asymptomatic HIV-infected children, and two phase I vaccine trials in HIV-exposed children, PACTG 230 and 326. While the results of PACTG 230 were encouraging, the gp120 subunit vaccines were not capable of generating cytotoxic T-cell (CTL) responses. A subsequent phase I study, PACTG 326, utilized a canarypox vectored HIV vaccine (ALVAC vCP205, Sanofi Pasteur), which was previously shown to generate CTL responses in HIV-uninfected adults. The vaccines were safe but the immunogenicity was poor when compared with results of adult studies. Specifically, no antibody responses were found, lymphoproliferative responses to HIV-specific antigens were found in <50% of vaccinees, and CTL responses, modest in nature, were seen in approximately 50% of vaccinees.Future planned vaccine studies are focused on prime-boost approaches, using live recombinant vectors or DNA vaccines combined with subunit vaccines to stimulate both cellular and antibody responses. HIV vaccines may have special utility in newborns, in infants who continue to breastfeed, and in pre-adolescent children before they become sexually active. However, to date, candidate HIV vaccines capable of generating robust immunologic responses in these populations have been disappointing.
Collapse
Affiliation(s)
- John S Lambert
- University of Maryland Institute of Human Virology, Baltimore, USA.
| |
Collapse
|
8
|
Reyes-Sandoval A, Fitzgerald JC, Grant R, Roy S, Xiang ZQ, Li Y, Gao GP, Wilson JM, Ertl HCJ. Human immunodeficiency virus type 1-specific immune responses in primates upon sequential immunization with adenoviral vaccine carriers of human and simian serotypes. J Virol 2004; 78:7392-9. [PMID: 15220412 PMCID: PMC434124 DOI: 10.1128/jvi.78.14.7392-7399.2004] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Two triple immunization vaccine regimens with adenoviral vectors with E1 deleted expressing Gag of human immunodeficiency virus type 1 were tested for induction of T- and B-cell-mediated-immune responses in mice and in nonhuman primates. The vaccine carriers were derived from distinct serotypes of human and simian adenoviruses that fail to elicit cross-neutralizing antibodies expected to dampen the effect of booster immunizations. Both triple immunization regimens induced unprecedented frequencies of gamma interferon-producing CD8(+) T cells to Gag in mice and monkeys that remained remarkably stable over time. In addition, monkeys developed Gag-specific interleukin-2-secreting T cells, presumably belonging to the CD4(+) T-cell subset, and antibodies to both Gag and the adenoviral vaccine carriers.
Collapse
|
9
|
Affiliation(s)
- Sandra A Calarota
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | | |
Collapse
|
10
|
Affiliation(s)
- John G McNeil
- National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892, and 2Walter Reed Army Institute of Research, Washington, DC 20307, USA.
| | | | | | | |
Collapse
|
11
|
Burton DR, Desrosiers RC, Doms RW, Feinberg MB, Gallo RC, Hahn B, Hoxie JA, Hunter E, Korber B, Landay A, Lederman MM, Lieberman J, McCune JM, Moore JP, Nathanson N, Picker L, Richman D, Rinaldo C, Stevenson M, Watkins DI, Wolinsky SM, Zack JA. Public health. A sound rationale needed for phase III HIV-1 vaccine trials. Science 2004; 303:316. [PMID: 14726576 DOI: 10.1126/science.1094620] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|