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The purpose of this study is to examine the ability of AGS-004 to control HIV-1 replication and to determine if HIV-1 immunotherapy made with dendritic cells is safe and well tolerated, to determine if immunotherapy increases the body's immune response to HIV-1; and, to determine if after stopping anti-HIV drugs, immunotherapy can control the HIV-1 virus.
Although chronic ART raises cluster of differentiation CD 4+ T cell counts and improves immune function, the immune systems' ability to control HIV-1 replication is not improved. AGS-004 is an immunotherapeutic agent made from autologous DCs co electroporated with amplified in vitro transcribed (IVT) ribonucleic acid (RNA) encoding CD40L and with IVT RNA encoding three or four autologous HIV-1 antigens. The HIV-1 RNA is derived from the plasma sample taken immediately prior to the initiation of ART.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| 1 | Experimental |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| AGS-004 | Biological | HIV-1 Immune Therapy |
|
| Measure | Description | Time Frame |
|---|---|---|
| Ability of AGS-004 therapy to improve immune control of HIV-1 replication | Study Week 26 through end of study |
| Measure | Description | Time Frame |
|---|---|---|
| Change in plasma HIV-1 RNA set point | Study Week 26 through end of study | |
| T cell responses to AGS-004 therapy and exploratory studies to investigate the mechanism of action of AGS-004. | Study Week 26 through end of study |
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Inclusion Criteria:
18 to 60 years of age
HIV-1 infection
Subjects must be on their first ART regimen for at least 3 months: 2 NRTIs together with an NNRTI and/or at least 1 PI (prior changes to ART regimen are allowed if due to tolerability, guideline change, or to simply dosing but not for viral control)
Durable viral suppression (below limit of detection) for at least 3 months prior ot Screening
CD4+ T cell count ≥ 450 cells/mm3 for at least 90 days immediately prior to Screening
Availability of ≥ 1.2 mL of continually frozen plasma (may have been thawed and refrozen only once) drawn no more than 90 days before starting ART and preferably within 30 days.
Pre-ART plasma HIV-1 RNA levels of ≥ 15,000 copies/mL at the time the plasma was archived before commencing ART
Pre-ART nadir CD4+ T cell count ≥ 200 cells/mm3 (cell count of < 200 cells/mm3 on one occasion is allowed if subsequent pre-ART CD4+ cell counts were > 200 cells/mm3 on at least two time points.
Laboratory values obtained at Screening and confirmed just prior to Baseline Day 1:
Female subjects of reproductive potential must have a negative serum or urine pregnancy test with a sensitivity of at most 50 mIU/mL performed within 30 days prior to Screening.
All subjects must agree not to participate in a conception process and use contraception.
Ability to communicate effectively with study personnel; considered reliable, willing, and cooperative in terms of compliance with the Protocol requirements.
Voluntary informed consent given to participate in the study.
Successful RNA amplification of at least 3 antigens (must include Gag).
Exclusion Criteria:
HIV-2 antibody positive.
Positive test for other infectious diseases including:
Any acute infection or serious medical illness within 14 days prior to study entry
History of lymph node irradiation or dissection
Pregnancy or breast-feeding
Previous use of any HIV-1 immunotherapy, including IL-2
Use of hydroxyurea within 30 days prior to Screening
Immunodeficiency other than HIV-1 or requirements to take immuno-modulating concomitant medications
Known allergy or sensitivity to the investigational immunotherapy or its formulation
Use of systemic corticosteroids and use of topical steroids over a total area exceeding 15 cm2 within 4 weeks of Screening or anticipated need for periodic use of corticosteroids during the study
Receipt of any immune modulators or suppressors within 30 days of Screening
Active autoimmune disease such as:
Type I diabetes mellitus (insulin therapy for Type II diabetes is permitted)
Participation in another clinical trial within 30 days of Screening or use of investigational agents (previous use of expanded access ARTs is permitted)
Body weight less than 30 kg.
Changes in ART regimen due to virologic failure (not including toxicities)
Presence of factors predicting insufficient adherence to the protocol.
Any condition that in the assessment of the investigator would indicate that it is not in the best interest of the subject or incompatible with the any aspect of the study design, treatment plan, and study objectives for a subject to participate.
History or other evidence of severe illness, malignancy, or any other condition that would make the subject, in the opinion of the investigator, unsuitable for the study.
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| Name | Affiliation | Role |
|---|---|---|
| Jean-Pierre Routy, MD | McGill University Health Centre/Research Institute of the McGill University Health Centre | Principal Investigator |
| Mona Loutfy, MD | Maple Leaf Clinic | Principal Investigator |
| Cecile Tremblay, MD | CHUM- Hotel Dieu de Montreal | Principal Investigator |
| John Gill, MD | Southern Alberta Clinic | Principal Investigator |
| Jean-Guy Baril, MD | Clinque Medical du Quartier Latin | Principal Investigator |
| Sylvie Vezina, MD | Clinque medicale l'Actuel | Principal Investigator |
| Jonathan B Angel, MD | The Ottawa Hospital | Principal Investigator |
| Sharon Walmsley, MD | UHN | Principal Investigator |
| Fiona Smaill, MD | Hamilton Health Sciences Corporation | Principal Investigator |
| Anita Rachlis, MD |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Practice Comprehensive Care Practice Div of Onfectious Disease & HIV Med | Philadelphia | Pennsylvania | 19102 | United States | ||
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| Safety and tolerability of AGS-004 | Study Week 26 through end of study |
| Sunnybrook Health Sciences Center |
| Principal Investigator |
| Julio Montaner, MD | Providence Health Care Society | Principal Investigator |
| Jeffrey Jacobson, MD | Partnership Comprehensive Care Practice | Principal Investigator |
| Southern Alberta Clinic |
| Calgary |
| Alberta |
| T2R0X7 |
| Canada |
| Providence Health Care Society / The University of British Columbia / BC Centre for Excellence in HIV/AIDS | Vancouver | British Columbia | V6Z1Y6 | Canada |
| Hamilton Health Sciences - McMaster University Medical Centre | Hamilton | Ontario | L7R3X5 | Canada |
| The Ottawa Hospital | Ottawa | Ontario | K1H8L6 | Canada |
| Sunnybrook Health Sciences Center | Toronto | Ontario | M4N3M5 | Canada |
| Maple Leaf Clinic | Toronto | Ontario | M5B 1L6 | Canada |
| UHN | Toronto | Ontario | M5G2C4 | Canada |
| Clinique medicale l'Actuel | Montreal | Quebec | H2L4P9 | Canada |
| Clinique Medical du Quartier Latin | Montreal | Quebec | H2L5B1 | Canada |
| Montreal Chest Institute | Montreal | Quebec | H2X 2P4 | Canada |
| CHUM | Montreal | Quebec | Canada |
| ID | Term |
|---|---|
| D015658 | HIV Infections |
| D000163 | Acquired Immunodeficiency Syndrome |
| ID | Term |
|---|---|
| D000086982 | Blood-Borne Infections |
| D003141 | Communicable Diseases |
| D007239 | Infections |
| D015229 | Sexually Transmitted Diseases, Viral |
| D012749 | Sexually Transmitted Diseases |
| D016180 | Lentivirus Infections |
| D012192 | Retroviridae Infections |
| D012327 | RNA Virus Infections |
| D014777 | Virus Diseases |
| D000091662 | Genital Diseases |
| D000091642 | Urogenital Diseases |
| D007153 | Immunologic Deficiency Syndromes |
| D007154 | Immune System Diseases |
| D012897 | Slow Virus Diseases |
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