A Phase I Randomized Clinical Trial of Candidate Human Immunodeficiency Virus type 1 Vaccine MVA.HIVA Administered to Gambian Infants

BACKGROUND: A vaccine to decrease transmission of human immunodeficiency virus type 1 (HIV-1) during breast-feeding would complement efforts to eliminate infant HIV-1 infection by antiretroviral therapy. Relative to adults infants have distinct immune development potentially high-risk of transmission when exposed to HIV-1 and rapid progression to AIDS when infected. To date there have been only three published HIV-1 vaccine trials in infants. TRIAL DESIGN: We conducted a randomized phase I clinical trial PedVacc 001 assessing the feasibility safety and immunogenicity of a single dose of candidate vaccine MVA.HIVA administered intramuscularly to 20-week-old infants born to HIV-1-negative mothers in The Gambia. METHODS: Infants were followed to 9 months of age with assessment of safety immunogenicity and interference with Expanded Program on Immunization (EPI) vaccines. The trial is the first stage of developing more complex prime-boost vaccination strategies against breast milk transmission of HIV-1. RESULTS: From March to October 2010 48 infants (24 vaccine and 24 no-treatment) were enrolled with 100% retention. The MVA.HIVA vaccine was safe with no difference in adverse events between vaccinees and untreated infants. Two vaccine recipients (9%) and no controls had positive ex vivo interferon-gamma ELISPOT assay responses. Antibody levels elicited to the EPI vaccines which included diphtheria tetanus whole-cell pertussis hepatitis B virus Haemophilus influenzae type b and oral poliovirus reached protective levels for the vast majority and were similar between the two arms. CONCLUSIONS: A single low-dose of MVA.HIVA administered to 20-week-old infants in The Gambia was found to be safe and without interference with the induction of protective antibody levels by EPI vaccines but did not alone induce sufficient HIV-1-specific responses. These data support the use of MVA carrying other transgenes as a boosting vector within more complex prime-boost vaccine strategies against transmission of HIV-1 and/or other infections in this age group. TRIAL REGISTRATION: ClinicalTrials.gov NCT00982579. The Pan African Clinical Trials Registry PACTR2008120000904116.