HIV Infections Clinical Trial
Official title:
Immunogenicity and Safety of a 9-valent Human Papillomavirus Vaccine in HIV-positive Women.
In adult HIV-positive patients, data on the safety and immunogenicity of the quadrivalent HPV
(qHPV) vaccine have been reported with excellent results (13 14); also, the results of a
clinical trial of qHPV vaccine conducted in seropositive patients older than 36 years (WLHIV
and MSM) have been published.
Even now, there is not a trial about immunogenicity and safety of a 9-valent human
papillomavirus vaccine in HIV-positive women; for this reason, the investigators plan to
conduct this clinical trial.
HYPOTHESYS: The administration of Nonavalent HPV vaccine (HPV-9) in adult women living with
HIV will produce antibodies against nine genotypes of HPV, thus preventing the acquisition of
new infections by those genotypes. Besides, this will prevent the cervical and anal dysplasia
in these women.
This is a phase IV (post-authorization study), open, single-arm trial of 9-valent human
papillomavirus (9-HPV) vaccine in HIV-positive women. The recruitment and follow-up period
will be 6 and 30 months, respectively.
At the initial clinical visit (V0), the conditions and objectives of the study were
explained. The details were summarised in a document, which was presented to the patient who
then signed the informed consent form. 2 mucosa samples were taken from the anal canal for
the detection and genotyping of the HPV and for anal cytology; and high resolution anoscopy
will be carried out. The patients will send to gynaecologist for exploration. Finally, full
blood haemogram and blood chemistry analysis were measured, together with cluster of
differentiation 4 (CD4), cluster of differentiation 8 (CD8) lymphocytes counts, HIV viral
load (VL) and antibodies against 9 genotypes of the 9-HPV vaccine. 9-HPV vaccine will be
administered at day 1 (V1), month 2 (V2) and month 6 (V3). Flow of subjects through the study
in graphic 1.
Settings and locations: The patients who enrolled were HIV-positive women that were attending
the Infectious Diseases Service of the "University Hospital Virgen de las Nieves", Granada
(Spain), "Hospitalary Complex Ciudad de Jaén" (Spain) and "University hospital San Cecilio",
Granada (Spain).
The purposes of the study were explained to the potential participants who then underwent
screening, and enrolled if they met the inclusion criteria for the trial. They were asked to
sign the fully informed consent form. The study will be conducted in compliance with ethical
and moral principles stated in the Declaration of Helsinki as well as the current Spanish
Laws on Biomedical Research(LEY 14/2007, de 3 de julio). Data were coded to ensure anonymity.
SAMPLE SIZE CONSIDERATIONS:
Currently, the rate of infections in unvaccinated women in the participating centers is 46.4%
(12). The efficacy rate of the tetravalent vaccine in the prevention of cervical cancer is
close to 100% and in the appearance of external anal lesions in men, around 85% (21).
Considering that in our study population, the effectiveness is at least 75%, to achieve an
accuracy of 5% in the estimation of a proportion through a normal 95% asymptotic confidence
interval, assuming that the proportion is 11, 6% (25% of 46.4%), it will be necessary to
include 158 women in the study. To this sample size will be added 10% in anticipation of
possible losses in the follow-up or dropouts.
DATA COLLECTION:
All data were collected and coded to ensure anonymity according to the current legal
requirements in Spain and European Union (EU) (GDPR Regulation (EU) 2016/679). At the initial
clinical visit (V0), the conditions and objectives of the study were explained to subjects.
The details were summarised in a document, which was presented to the patient who then signed
the informed consent form.
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