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Co-infections and Related Conditions (CRC)


CTN 236: HPV vaccine in HIV positive girls and women

A study of an HPV VLP vaccine in a cohort of HIV positive girls and women

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About this study

The purpose of this study is to investigate the safety and immunogenicity of the human papillomavirus (HPV) vaccine in girls and women age 9 years and older who are infected with HIV. Immunogenicity refers to the ability of a treatment to stimulate different immune system responses needed to fight a virus. Specifically, this research is looking at a vaccine that protects against four strains of HPV, known as a quadrivalent vaccine (Gardasil). Through this study, researchers have attempted to determine the antibody responses to the four types of HPV covered by the vaccine, the rate of adverse events in girls and women after receiving Gardasil, and secondarily, the efficacy of the vaccine in preventing HPV-associated cervical cancer and genital warts in women living with HIV. The initial phase of this research included eight planned visits, beginning with three vaccination visits where an injection containing .5 ml of the vaccine was administered to participants. Participants were followed for approximately 24 months after the first dose of vaccine. A secondary follow-up study is underway to examine the long-term response to the HPV vaccine over an additional 3-year period.

About the disease/condition

HPV is common and has about 30 different types that infect the genital area. HPV is the leading cause of cervical cancer and genital warts, although only a small number of people infected with HPV will go on to develop cervical cancer or genital warts. HPV is spread through close skin and/or sexual contact. HIV-positive women are known to have higher rates of HPV and more rapid progression to cervical cancer, which is believed to be caused by a decrease in immune function. In addition, HIV-positive women with HPV can suffer from severe cases of genital warts that are very difficult to treat.

Study Approach

The qHPV vaccine protects against new infections of four types of HPV: two of these types are associated with genital warts while the other two are the high-risk, cancer-causing HPV types. Previous studies of qHPV have shown effective protection against these types of HPV in HIV-negative girls and women who were not previously exposed to the four types of HPV that the vaccine protects against. When CNT 236 began, no previous studies had evaluated the safety and efficacy of qHPV in HIV-positive people. Researchers are seeking to determine whether girls and women with HIV can be protected from some or all of the types of HPV that the vaccine protects against. The initial phase of CTN 236 is no longer enrolling. Currently, the secondary phase of CTN 236 is enrolling women that participated in the initial study. This long-term follow-up study will assess the ability of the Gardasil vaccine to maintain a protective immune response to four HPV strains in HIV-positive girls and women over an additional 3 years (3 study visits).

Preliminary Results

Results from the initial phase of the study showed that HIV-positive women had a comparable immune response to the qHPV vaccine compared to published data on HIV-negative women. The study highlighted the impact of HIV viral load on HPV vaccine immune response. Dr. Money and her team found that women with a fully suppressed HIV viral load had a better immune response compared to women without a fully suppressed viral load. The study also showed that this vaccine may be beneficial to older HIV-positive women, who are above the typical age range for vaccination.

A second publication analyzing the same data in a cohort of girls aged 9-13 living with HIV showed that the vaccine was not as effective; their immune response to the vaccine was lower compared to their HIV-negative peers. In both girls and women, virologic suppression of HIV predicted a stronger vaccine immune response. A follow-up paper published in the summer of 2018 demonstrated the vaccine’s efficacy over a two year period. The publication showed that the rate of HPV infection was greatly diminished compared to rates seen in unvaccinated women and girls living with HIV.

Publications

Money D, Moses E, Blitz S, Vandriel SM, Lipsky N, Walmsley  SL, Loutfy M, Trottier S, Smaill F, Yudin M, Klein M, Harris M, Cohen J, Wobeser W, Bitnun A, Lapointe N, Samson L, Brophy J, Karatzios C, Ogilvie G, Coutlée F, Raboud  J;  the HPV in HIV Study Group. HIV viral suppression results in higher antibody responses in HIV-positive women vaccinated with the quadrivalent human papillomavirus vaccine. Vaccine. 2016 Sep,34(4). 4799-806. PMID:27544584

Brophy J, Bitnun A, Alimenti A, Lapointe N, Samson L, Read S, Karatzios C, Dobson S, Moses E, Blitz S, Lipsky N, Ogilvie O, Walmsley S, Raboud J, Money D; the HPV in HIV Study Group. Immunogenicity and Safety of the qHPV Vaccine in HIV Positive Girls. Pediat Infect Dis J. 2018 Jun;37(6):595-7. 10.1097/INF.0000000000001874.

McClymont E, Lee M, Raboud JM, Coutlée F, Walmsley SL, Lipsky N, Loutfy MR, Trottier S, Smaill F, Klein MB, Harris M, Cohen J, Yudin MH, Wobeser W, Money D; CTN 236 HPV in HIV Study Team. The Efficacy of the Quadrivalent Human Papillomavirus Vaccine in Girls and Women Living with HIV. Clin Infect Dis. 2018 Jul epub ahead of print.. doi:10.1093/cid/ciy575.

Additional Information

If you would like more information on this clinical study, please refer to a participating site or the national project manager:

Nancy Lipsky
nlipsky@cw.bc.ca
604-875-2424 Ext. 4877
 

Participating Clinical Sites:

British Columbia:
Oak Tree Clinic, Vancouver
St. Paul’s Infectious Disease Clinic, Vancouver

Ontario:
Toronto General Hospital
Maple Leaf Medical Clinic
St. Michaels Hospital
Hospital for Sick Children, Toronto
McMaster University Hospital, Hamilton
Kingston General Hospital
Children’s Hospital of Eastern Ontario, Ottawa
HIV Care Program, Windsor

Quebec:
McGill University Health Centre, Montreal
Montreal Children’s Hospital
CHU Sainte Justine, Montréal
Centre Hospitalier de l’Université Laval, Québec City

Participating Laboratories:

BC Cancer Agency (Cytology)
British Columbia Centre for Disease Control (Cytology handling)
Dr Francois Coutlee Lab, University of Montreal (HPV DNA)
Dr Janet Hill Lab, University of Saskatchewan (Vaginal microbiome testing)
Dr Janet Raboud, University Health Network (Statistics)
Canadian HIV Trials Network (Data management)
Merck / PPD Laboratories (HPV antibody testing)

Principal Investigator

Dr. Deborah Money
Executive Vice-Dean | Faculty of Medicine
The University of British Columbia
317-2194 Health Sciences Mall
Vancouver, BC  Canada V6T 1Z3
Phone 604 827 0327 | deborah.money@ubc.ca

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