Phase I randomized clinical trial of VRC DNA and rAd5 HIV-1 vaccine delivery by intramuscular (i.m.), subcutaneous (s.c.) and intradermal (i.d.) administration (VRC 011).

Publication Type
Journal Article
Year of Publication
Enama, Mary E; Ledgerwood, Julie E; Novik, Laura; Nason, Martha C; Gordon, Ingelise J; Holman, LaSonji; Bailer, Robert T; Roederer, Mario; Koup, Richard A; Mascola, John R; Nabel, Gary J; Graham, Barney S; VRC 011 Study Team
PLoS One
Date Published
Adenoviridae; Adolescent; Adult; AIDS Vaccines; Antibodies, Viral; DNA, Recombinant; Female; Humans; Injections, Intradermal; Injections, Intramuscular; Injections, Subcutaneous; Male; Middle Aged; safety; T-Lymphocytes; Vaccines, DNA

BACKGROUND: Phase 1 evaluation of the VRC HIV DNA and rAd5 vaccines delivered intramuscularly (i.m.) supported proceeding to a Phase 2 b efficacy study. Here we report comparison of the i.m., subcutaneous (s.c.) and intradermal (i.d.) routes of administration.

METHODS: Sixty subjects were randomized to 6 schedules to evaluate the i.m., s.c. or i.d. route for prime injections. Three schedules included DNA primes (Wks 0,4,8) and 3 schedules included rAd5 prime (Wk0); all included rAd5 i.m. boost (Wk24). DNA vaccine dosage was 4 mg i.m. or s.c., but 0.4 mg i.d., while all rAd5 vaccinations were 1010 PU. All injections were administered by needle and syringe.

RESULTS: Overall, 27/30 subjects completed 3 DNA primes; 30/30 subjects completed rAd5 primes. Mild local pruritus (itchiness), superficial skin lesions and injection site nodules were associated with i.d. and s.c., but not i.m. injections. All routes induced T-cell and antibody immune responses after rAd5 boosting. Overall, >95% had Env antibody and >80% had Env T-cell responses.

CONCLUSIONS: The pattern of local reactogenicity following i.d. and s.c. injections differed from i.m. injections but all routes were well-tolerated. There was no evidence of an immunogenicity advantage following s.c. or i.d. delivery, supporting i.m. delivery as the preferred route of administration.