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Trial details imported from ClinicalTrials.gov

For full trial details, please see the original record at https://clinicaltrials.gov/ct2/show/NCT05187429




Registration number
NCT05187429
Ethics application status
Date submitted
15/12/2021
Date registered
11/01/2022
Date last updated
12/02/2024

Titles & IDs
Public title
Low Dose Nivolumab in Adults Living With HIV on Antiretroviral Therapy
Scientific title
Safety, Immunogenicity and Efficacy of Low Dose Nivolumab in Adults Living With HIV on Antiretroviral Therapy (ART)
Secondary ID [1] 0 0
358/20
Universal Trial Number (UTN)
Trial acronym
NIVO-LD
Linked study record

Health condition
Health condition(s) or problem(s) studied:
HIV I Infection 0 0
Condition category
Condition code

Intervention/exposure
Study type
Interventional
Description of intervention(s) / exposure
Treatment: Drugs - Nivolumab 10 MG/ML [Opdivo]
Treatment: Drugs - Nivolumab 10 MG/ML [Opdivo]
Treatment: Drugs - Saline

Experimental: Dose escalation phase (Cohort A) - Drug: Nivolumab Dose form: infusion Dose route: intravenous Dosage: 0.1, 0.3 or 1.0 mg/kg Duration: Single dose administered on Study Day 7

Experimental: Randomization phase (Cohort B) - Drug: Nivolumab Dose form: infusion Dose route: intravenous Dosage: determined from Cohort 1 Duration: single dose administered on Day 0 (baseline)

Placebo Comparator: Randomization phase comparator (Cohort B) - Comparator: saline Dose form: infusion Dose route: intravenous Duration: single dose administered on Day 0 (baseline)


Treatment: Drugs: Nivolumab 10 MG/ML [Opdivo]
Cohort A: Dose escalation phase: Nivolumab will be administered intravenously as a single dose in the dose escalation phase.

Treatment: Drugs: Nivolumab 10 MG/ML [Opdivo]
Cohort B: Randomisation phase: Nivolumab will be administered intravenously as a fixed single dose in the randomisation phase.

Treatment: Drugs: Saline
Cohort B: Randomisation phase: Saline will be administered intravenously as a single dose in the randomisation arm.
Intervention code [1] 0 0
Treatment: Drugs
Comparator / control treatment
Control group

Outcomes
Primary outcome [1] 0 0
Number of participants with treatment-emergent adverse events enrolled in Cohort A
Timepoint [1] 0 0
18 weeks
Primary outcome [2] 0 0
Number of participants with treatment-emergent adverse events enrolled in Cohort B
Timepoint [2] 0 0
24 weeks
Secondary outcome [1] 0 0
Change in PD-1 receptor occupancy in peripheral blood following a single low dose of nivolumab in participants enrolled in Cohort A
Timepoint [1] 0 0
Day 7, Day 14, Day 21, Day 35, Day 63, Day 91, Day 126
Secondary outcome [2] 0 0
Change in PD-1 receptor occupancy in lymph node T-cells following a single low dose of nivolumab in participants enrolled in Cohort A.
Timepoint [2] 0 0
Day 21
Secondary outcome [3] 0 0
Cohort A: T-cell responses to Gag peptides
Timepoint [3] 0 0
Day 0, Day 126
Secondary outcome [4] 0 0
Cohort A: T-cell responses to Pol/Env/Nef peptides
Timepoint [4] 0 0
Day 0, Day 126
Secondary outcome [5] 0 0
Change in PD-1 receptor occupancy in peripheral blood following a single low dose of nivolumab in participants enrolled in Cohort B
Timepoint [5] 0 0
Day 0, Day 7, Day 28, Day 168
Secondary outcome [6] 0 0
Cohort B: HIV RNA
Timepoint [6] 0 0
5 weeks
Secondary outcome [7] 0 0
Cohort B: viral rebound
Timepoint [7] 0 0
5 weeks
Secondary outcome [8] 0 0
Cohort B: T-cell responses to Gag peptides
Timepoint [8] 0 0
Day 7, Day 168
Secondary outcome [9] 0 0
Cohort B: T-cell responses to Pol/Env/Nef peptides
Timepoint [9] 0 0
Day 7, Day 168

Eligibility
Key inclusion criteria
- Documented HIV-1 infection;

- Viral load > 400 copies/mL prior to initiation of ART;

- Weight = 50 kg;

- Ability and willingness to provide informed consent and to continue ART throughout the
study;

- Receiving combination ART for at least 2 years and being on the same ART regimen for
at least 4 weeks at the screening visit;

- HIV-1 plasma RNA <50 copies/mL for >2 years (documented on at least 2 occasions within
the 2 years) and <50 copies/mL at screening. Episodes of a single HIV plasma RNA
50-500 copies/mL will not exclude participation if the subsequent HIV plasma RNA was
<50 copies/mL;

- CD4+ T cell counts >500 cells/µL at screening;

- Female participants if they meet one of the following criteria:

- Is of non-child-bearing potential defined as either post-menopausal (12 months of
spontaneous amenorrhea and = 45 years of age) or physically incapable of becoming
pregnant with documented tubal ligation, hysterectomy or bilateral oophorectomy
or,

- Is of child-bearing potential with a negative pregnancy test at both Screening
and Day 0 and agrees to use one of the following methods of contraception to
avoid pregnancy from 14 days prior to the first infusion until the end of the
study:

- Complete abstinence from penile-vaginal intercourse;

- Double barrier method (male condom/spermicide, male condom/diaphragm,
diaphragm/spermicide);

- Any intrauterine device (IUD) with published data showing that the expected
failure rate is <1% per year;

- Male partner sterilization confirmed prior to the female participant's entry
into the study, and this male is the sole partner for that participant;

- Approved hormonal contraception (Where other medications to be used in the
study (e.g., efavirenz and darunavir) are known, or are likely, to
significantly interact with systemic contraceptives, resulting in decreased
efficacy of the contraceptive, then alternative methods of non-hormonal
contraception are recommended);

- Any other method with published data showing that the expected failure rate
is <1% per year. Note: If using one of the described contraception methods
it must be used consistently, in accordance with the approved product label
and all female participants must be willing to undergo urine pregnancy tests
as specified in the Schedule of Procedures.

- All participants must agree not to participate in a conception process (e.g. active
attempt to become pregnant or to impregnate, sperm donation, in vitro fertilization,
egg donation) during the study;

- Heterosexually active male if they are;

- willing to use an effective method of contraception (anatomical sterility in self
that is confirmed prior to study entry) or

- agree on the use of an effective method of contraception with an effective
failure rate of < 1% by his partner (hormonal contraception, intra-uterine device
(IUD), or anatomical sterility) from the day of the first infusion until the end
of study (as long as plasma viral load <20c/mL).
Minimum age
18 Years
Maximum age
65 Years
Sex
Both males and females
Can healthy volunteers participate?
No
Key exclusion criteria
- Active, known and suspected autoimmune disease (including but not limited to including
but not limited to inflammatory bowel diseases, scleroderma, severe psoriasis,
myocarditis, uveitis, pneumonitis, systemic lupus erythematosus, rheumatoid arthritis,
optic neuritis, myasthenia gravis, adrenal insufficiency, hypothyroidism and/or
hyperthyroidism, autoimmune thyroiditis, sarcoidosis, and vitiligo);

- History of interstitial lung disease;

- History of chronic obstructive pulmonary disease (COPD);

- Type I diabetes mellitus;

- Active malignancy or history of malignancy requiring systemic chemotherapy or surgery
in the preceding 24 months; exception -history of excised localized non-melanomatous
skin cancers (squamous cell carcinoma, basal cell carcinoma);

- History of solid organ transplant. Note Individuals with prior corneal transplants may
be allowed to enrol after discussion with and approval from the study principal
investigator;

- Active or previously treated active TB;

- History of HIV-related opportunistic infection within the last years prior to study
entry;

- Prior history of immune reconstitution syndrome (IRIS);

- Current, chronic, acute or recurrent bacterial, fungal or viral (other than HIV)
infections that are serious, in the opinion of the investigator, and require systemic
therapy within 30 days prior to study entry;

- Immune deficiency other than that caused by HIV infection;

- Received investigational drug or device within 6 months prior to study entry

- Treatment for hepatitis C virus (HCV) within 6 months prior to study entry;

- History of previous treatment with an immune checkpoint inhibitor;

- History of prior immunoglobulin (IgG) therapy;

- Use of immunomodulators (e.g., interleukins, interferons, cyclosporine), systemic
cytotoxic chemotherapy, experimental vaccines or investigational therapy within 60
days prior to study entry or intent to use immunomodulators during the study. NOTE:
Participants receiving stable physiologic glucocorticoid doses, defined as
prednisolone less than or equal to 10 mg/day or the equivalent, will not be excluded.
Stable physiologic glucocorticoid doses should not be discontinued for the duration of
the study. In addition, participants receiving inhaled or topical corticosteroids will
not be excluded;

- Any other current or prior therapy which, in the opinion of the investigators, would
make the individual unsuitable for the study or influence the results of the study;

- Participants with severe hepatic impairment (Class C) as determined by Child-Pugh
classification;

- Unstable liver disease (as defined by the presence of ascites, encephalopathy,
coagulopathy, hypoalbuminemia, esophageal or gastric varices, or persistent jaundice),
known biliary abnormalities (with the exception of Gilbert's syndrome or asymptomatic
gallstones);

- Patients who intend to modify their ART regimen within the study period;

- Active alcohol or substance use that in the opinion of the investigator will prevent
adequate compliance with study procedures;

- Any acute or chronic psychiatric problems that, in the opinion of the investigator,
make the participant ineligible for participation;

- Any active, clinically significant medical condition not otherwise covered;

- Women who are pregnant or breastfeeding or Women of Child Bearing Potential (WOCBP)
who are unwilling or unable to use an acceptable method of contraception to avoid
pregnancy as specified in the inclusion criteria;

- Men of reproductive potential who are unwilling or unable to use an acceptable method
of contraception to avoid pregnancy as specified in the inclusion criteria;

- Specific exclusion criteria for Cohort A (Fine Needle Biopsy):

- prothrombin time (PTT) >2x ULN

- international normalized ratio (INR) >1.5

- Platelets <50,000/mm3

- Chronic venous stasis of lower extremities

- Lower extremity lymphedema

- Allergies to local anaesthetic

- Blood coagulation disorder.

- The following laboratory abnormalities (lab tests may be repeated to obtain acceptable
values before failure at screening is concluded);

- Haematology:

- Haemoglobin < 14.0 g/dl for men and <12.0 g/dL for women;

- Absolute Neutrophil Count (ANC) = 1,500 /mm3 (= 1 x 10^9/l);

- Platelets = 150,000 /mm3

- Biochemistry:

- Aspartate aminotransferase (AST) > 1.25 x ULN;

- Alanine aminotransferase (ALT) > 1.25 x ULN;

- Bilirubin =1.5 x ULN (if on atazanavir =5 x ULN);

- Interferon-gamma release assay (IGRA) for tuberculosis (TB) with negative
results within 90 days prior to study entry

- Thyroid stimulating hormone (TSH) outside the normal reference range;

- Free thyroxine (T4) outside the normal reference range

- Presence of Anti-thyroid peroxidase (TPO) antibodies;

- Presence of anti-glutamic acid decarboxylase (GAD) antibodies

- Antinuclear antibody (ANA) >1:80 at screening

- Early morning (8-9 am) cortisol outside the normal reference range. Female
participants on estrogen-containing oral contraception or other exogenous
estrogen treatment may repeat the AM cortisol as part of screening to
determine eligibility;

- Fasting blood sugar within normal limits (unless already diagnosed with Type
2 Diabetes Mellitus);

- Microbiology:

- Positive for hepatitis B surface antigen;

- Positive for hepatitis C antibody, unless confirmed clearance of HCV
infection (spontaneous or following treatment) by polymerase chain reaction
(PCR) testing.

Study design
Purpose of the study
Treatment
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Masking / blinding
Blinded (masking used)
Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s

The people analysing the results/data
Intervention assignment
Other
Other design features
Phase
Phase 1/Phase 2
Type of endpoint/s
Statistical methods / analysis

Recruitment
Recruitment status
Recruiting
Data analysis
Reason for early stopping/withdrawal
Other reasons
Date of first participant enrolment
Anticipated
Actual
24/01/2023
Date of last participant enrolment
Anticipated
Actual
Date of last data collection
Anticipated
1/01/2026
Actual
Sample size
Target
42
Accrual to date
Final
Recruitment in Australia
Recruitment state(s)
VIC
Recruitment hospital [1] 0 0
Alfred Hospital - Department of Infecious Diseases - Melbourne
Recruitment postcode(s) [1] 0 0
3181 - Melbourne
Recruitment outside Australia
Country [1] 0 0
Singapore
State/province [1] 0 0
Singapore

Funding & Sponsors
Primary sponsor type
Other
Name
University of Melbourne
Address
Country
Other collaborator category [1] 0 0
Other
Name [1] 0 0
The Alfred
Address [1] 0 0
Country [1] 0 0

Ethics approval
Ethics application status

Summary
Brief summary
The purpose of this study is to evaluate whether a single dose of Nivolumab in people living
with HIV can reduce the latent reservoir. The latent HIV reservoir is a group of immune
system cells in the body that are infected with HIV but are not actively producing new virus.
This is the reason why people living with HIV are unable to stop their antiretroviral
treatment.
Trial website
https://clinicaltrials.gov/ct2/show/NCT05187429
Trial related presentations / publications
Public notes

Contacts
Principal investigator
Name 0 0
Sharon Lewin
Address 0 0
University of Melbourne
Country 0 0
Phone 0 0
Fax 0 0
Email 0 0
Contact person for public queries
Name 0 0
Barbara Scher
Address 0 0
Country 0 0
Phone 0 0
+61 (0)3 8344 0770
Fax 0 0
Email 0 0
barbara.scher@unimelb.edu.au
Contact person for scientific queries



Summary Results

For IPD and results data, please see https://clinicaltrials.gov/ct2/show/NCT05187429