Addition of Raltegravir to Established Antiretroviral Suppressive Therapy
Status and phase
Conditions
Treatments
Details and patient eligibility
About
This study will examine whether intensification with raltegravir of a suppressive antiretroviral regimen in HIV infected patients with poor immune restoration has a beneficial effect on cryptic viral replication and the immune system. Specifically, the investigators will examine the effect that raltegravir intensification of ART has on episomal cDNA frequencies, immune activation, CD4+ cell counts and apoptosis, and markers of microbial translocation.
Full description
This is a single-center, open-label, double-arm, crossover study which will include approximately 40 HIV-infected subjects on an established suppressive HAART for at least 2 years with evidence of undetectable HIV-1 RNA levels (either <50 copies/ml by RT-PCR or <75 copies/ml by bDNA assay) and CD4+ count of <350 cells/mm3 or an increase in CD4+count <100 cells/mm3 in the last 2 years. Participants (~20 Group 1 and ~20 in Group 2) will be randomly assigned to 1 of the 2 treatment arms described below in Table 1:
Table 1. Study groups and treatment assignments
Group A Raltegravir 400 mg PO q12h in addition to established ART (Part 1) followed by a washout period only on ART (Part 2) followed by ART (Part 3)
Group B Established ART (Part 1) followed by a washout period only on ART (Part 2) followed by raltegravir 400 mg PO q12h in addition to ART (Part 3)
The participants' pre-study HAART will be monitored so as to ensure that the distribution of NNRTI to PI-based regimens is roughly 1:1 and no higher than 2 (NNRTI):1 (PI).
The total duration of the study will be 40 weeks. This will include Part 1 (16 weeks) followed by Part 2 (8 weeks) followed by the crossover to Part 2 (16 weeks) (Figure 1). During Part 1 participants in Group A will receive open-label raltegravir in addition to their established antiretroviral regimen while Group B participants will continue taking their established antiretroviral regimen for 16 weeks. After completion of Part 1, both groups will enter Part 2 that will consist of a washout period of 8 weeks during which both groups will only take their established antiretroviral regimen without raltegravir. This will be followed by Part 3 during which the two study groups will undergo a crossover with respect to the treatment assignment during Part 1 so that Group A will continue to receive their established antiretroviral regimen while Group B will receive open-label raltegravir in addition to their established antiretroviral regimen for 16 weeks.
After obtaining informed consent, patients will be enrolled into the study, a study number will be assigned, a complete history will be obtained, and a physical exam will be performed. Blood will be drawn for the following laboratory exams at Day 1 and at Weeks 1, 2, 4, 10, 16, 24, 25 26, and 40 for Group A and at Day 1 and at Weeks 1, 2, 16, 24, 25, 26, 28, 34, and 40 for Group B:
- T-cell subsets
- Plasma viral load
- Episomal viral cDNA PCR
- HLA-DR levels
- CD38 levels
Blood will also be drawn for the following laboratory exams at Day 1 and at Weeks 4, 12, 16, 24, 28, 36, and 40 for both Group A and Group B to determine
- Plasma levels of LPS, 16s ribosomal DNA, and sCD14
- T cell receptor excision circles
- CD4+ and CD8+ T-cell apoptosis
At all visits, a directed physical exam will be performed on an as-needed-basis.
Enrollment
Sex
Ages
Volunteers
Inclusion criteria
To qualify for this study, participants will need to have:
- At least 18 years of age
- Documented HIV-1 infection
- CD4+ count <350 cells/mm3 at the time of enrollment or CD4+ count increase of <100 cells/mm3 within the past 2 years
- Plasma viral load <400 copies/ml at all testing time points within the preceding 2 years AND <50 copies/ml by RT-PCR or <75 copies/ml by bDNA at the 2 testing time points immediately preceding enrollment into the study
Exclusion criteria
To qualify for this study, patients must not meet any of the following exclusion criteria:
- Pregnancy or breast-feeding
- Prior use of raltegravir at any time in the past
- Use of any investigational, immunomodulatory, immunosuppressive agents within 90 days prior or during this study
- Alcohol or substance abuse that in the opinion of the investigator might interfere with patient compliance or safety
- Any condition or pre-study laboratory abnormality that in the opinion of the investigator might interfere with patient compliance or safety
Trial design
Primary purpose
Allocation
Interventional model
Masking
15 participants in 2 patient groups
Trial contacts and locations
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Data sourced from clinicaltrials.gov
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