HIV Infections Clinical Trial
Official title:
Combination Latency Reversal With High Dose Disulfiram Plus Vorinostat in HIV-infected Individuals on ART (DIVA): A Single Arm Clinical Trial
Verified date | June 2023 |
Source | University of Melbourne |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
Antiretroviral therapy (ART) dramatically reduces Human Immunodeficiency Virus (HIV) replication leading to restoration of immune function and a near normal life expectancy, but treatment is lifelong and there is no cure. The major barrier to a cure is the persistence of long lived cluster of differentiation 4 (CD4+) T-cells that contain a "silenced" form of HIV, called HIV latency. The purpose of this research is to investigate whether it may be possible to reduce the amount of dormant HIV infection in immune cells, by "turning on" or activating the virus and hence force it out of the latently infected memory T cells. This leads to production of HIV by the cell, which will either die or will be recognized and eliminated by the immune system. As very few T cells are latently infected with HIV, the death of these cells is not expected to affect the function of the immune system and further infection of new cells is expected to be prevented by ART.
Status | Terminated |
Enrollment | 5 |
Est. completion date | April 9, 2019 |
Est. primary completion date | April 9, 2019 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years to 65 Years |
Eligibility | Inclusion Criteria: - Age 18-65 years with documented HIV-1 infection (antibody positive or detectable plasma HIV-1 RNA) - Receiving combination ART with plasma HIV RNA <50 copies/mL for >3 years - CD4+ T cell count >350 microliter at screening - Able to provide informed consent - Willing to abstain from alcohol consumption from one day before to 14 days after completing 28 days of disulfiram - One month post influenza vaccine (from screening visit) - Women of non-child-bearing potential defined as > 12 months of spontaneous amenorrhea and = 45 years of age, or documented medical history of one of the following: hysterectomy, bilateral oophorectomy or tubal ligation. - Women of Child Bearing Potential (WOCBP) with a negative pregnancy test at Screening and agrees to use one of the study protocol specified methods of contraception to avoid pregnancy Exclusion Criteria: - Current alcohol use disorder or hazardous alcohol use (>7 drinks per week for women or > 14 drinks per week for men) as determined by clinical evaluation - Current or recent (in the last 4 days) use of metronidazole or any drug formulation that contains alcohol or that might contain alcohol, including the gelatin capsule and liquid formulations of ritonavir, ritonavir/lopinavir, amprenavir and fosamprenavir, and alcohol-containing preparations such as cough syrups, tonics etc. - Current use of tipranavir or Maraviroc - Current use of zidovudine, stavudine or didanosine (as disulfiram potentially has potent irreversible inhibitory effects on mitochondrial metabolism and hence could exacerbate the toxicity of these drugs) - Concurrent use of rivaroxaban (a CYP3A metabolized medication) as the cytochrome P450 inhibitory effects of disulfiram on rivaroxaban are unknown - Current use of warfarin - Individuals who intend to modify antiretroviral therapy during the study period for any reason - Significant myocardial disease (current myocarditis or reduced left ventricular ejection fraction below the lower limit of normal) or diagnosed coronary artery disease - Significant renal disease (eGFR <50 milliliter/minute) - History of psychosis, seizure disorder, abnormal electroencephalogram or brain damage with significant persisting neurological deficit - Prior malignancy active within the previous 3 years except for local curable cancers that have been apparently cured, such as basal or squamous cell skin cancer, superficial bladder cancer or carcinoma in situ of the prostate, cervix or breast. - Known hypersensitivity to disulfiram or vorinostat or contraindications to treatment with these agents - Participation in another latency reversal study or receipt of vorinostat or disulfiram in the previous 12 months before starting the investigational treatment - Any significant acute medical illness requiring hospitalization within preceding 8 weeks - Hepatitis B (HBV) or hepatitis C (HCV) co-infection as determined by detection of HBsAg or HCV RNA (Individuals with prior hepatitis infection that is now cleared are eligible for enrolment) - Receipt of immunomodulating agents (excluding immunization) or systemic chemotherapeutic agents within 28 days prior to study entry - Current or recent gastrointestinal disease or surgery that may impact the absorption of the investigational drug - Active substance use that in the opinion of the investigator will prevent adequate compliance with study procedures - Women who are currently pregnant or breastfeeding - Women of Child Bearing Potential (WOCBP) who are unwilling or unable to use an acceptable method of contraception to avoid pregnancy - Unable or unwilling to adhere to protocol procedures - The following laboratory values within 6 weeks before starting the investigational drug (lab tests may be repeated to obtain acceptable values before failure at screening is concluded) - Hepatic transaminases (AST or ALT) =3 x upper limit of normal (ULN) - Serum total bilirubin =1.5 x ULN - eGFR <50 milliliter/min - Hemoglobin <11.0 g/deciliter - Platelet count =100 x10^9/L (liter) - Absolute neutrophil count =1.5x10^9/L - Serum potassium, magnesium, phosphorus outside normal limits - Total calcium (corrected for serum albumin) or ionized calcium = lower normal limits |
Country | Name | City | State |
---|---|---|---|
Australia | Department of Infectious Diseases, Alfred Hospital | Melbourne | Victoria |
Lead Sponsor | Collaborator |
---|---|
University of Melbourne | Merck Sharp & Dohme LLC, The Alfred |
Australia,
McMahon JH, Evans VA, Lau JSY, Symons J, Zerbato JM, Chang J, Solomon A, Tennakoon S, Dantanarayana A, Hagenauer M, Lee S, Palmer S, Fisher K, Bumpus N, Heck CJS, Burger D, Wu G, Zuck P, Howell BJ, Zetterberg HH, Blennow K, Gisslen M, Rasmussen TA, Lewin — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | HIV RNA Transcription Relative to Baseline at Additional Time Points | This secondary outcome was to measure HIV transcription measured by cell-associated unspliced HIV RNA (CA-US HIV RNA) in peripheral blood CD4+ T cells relative to baseline | Baseline to Days 8, 11, 15, 21, 38, 59, 196, 197. Data is reported for days where samples were collected for each participant. | |
Other | Cell Associated Total HIV DNA Relative to Baseline at Additional Points | This outcome was to measure Cell-associated total and integrated HIV DNA in peripheral blood CD4+ T cells relative to baseline | Baseline and Days 38, 59, 196 and 197. Data is reported for days where results are available for each participant. | |
Other | Cell-associated Integrated HIV DNA Relative to Baseline at Additional Points | This outcome was to measure cell-associated integrated HIV DNA in peripheral blood CD4+ T cells relative to baseline | Baseline to Days 38, 59, 197, 196. Data is reported for days where samples were collected for each participant. | |
Other | HIV Levels Relative to Baseline | This outcome was to measure the frequency of inducible virus as measured by Tat/rev limiting dilution assay (TILDA) in peripheral blood CD4+ T cells relative to baseline. Not conducted as part of the analysis and there are no future plans to assess this outcome, as analysis from 2 participants would not provide any meaningful results, given that the participants did not manage to complete the treatment course. |
Day 56 | |
Other | Vorinostat Concentration in Plasma | This outcome was to measure the concentrations of vorinostat (including its metabolites) in plasma. | Baseline and days 8, 11, 15, 21, 37, 58. Data is reported for days where samples were collected for each participant. | |
Other | Disulfiram Concentration in Plasma | This outcome was to measure the concentrations of disulfiram (including its metabolites) in plasma | Days 8, 11, 22, 25, 28, 56 and 196 Data is reported for days where samples were collected for each participant. | |
Other | p24 Expression in CD4+ T-cells Relative to Baseline | This outcome was to measure the p24 expression in CD4+ T-cells relative to baseline | Baseline and Days 8, 11, 15, 21, 37, 58, 196 and 197. Data is reported for days where samples were collected for each participant. | |
Primary | Day 11 Plasma HIV RNA Relative to Baseline | The primary endpoint was to determine the change from baseline to day 11 of plasma HIV RNA levels after 11 continuous days of disulfiram with administration of vorinostat on days 8, 9 and 10 in HIV infected individuals on suppressive ART. | Baseline and 11 days | |
Secondary | Incidence of Treatment-Emergent Adverse Events | This secondary outcome was to determine the Incidence of treatment-emergent adverse events [Safety and Tolerability] during a 28 day course of continuous disulfiram with intermittent administration of 3 days of vorinostat on two occasions in HIV infected individuals on suppressive ART. An adverse event is defined as any untoward medical occurrence in a clinical study participant, temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. An SAE is defined as any untoward medical occurrence that; results in death, is life-threatening, requires hospitalization or prolongation of existing hospitalization, results in disability/incapacity, is a congenital anomaly/birth defect, other situations as judged by physician. Systematic assessments of adverse events were performed at each visit, including unscheduled visits |
Adverse events were collected continuously throughout the study duration from day 1 on treatment until 2 months since last dose of study drug, an average duration of 3 months | |
Secondary | Plasma HIV RNA Relative to Baseline at Additional Time Points | This secondary outcome was to determine the fold change in plasma HIV RNA levels at additional time points during and after 11 continuous days of disulfiram with administration of vorinostat on days 8, 9 and 10 in HIV infected individuals on suppressive ART. | Baseline to Days 8, 15, 21, 38, 59, 196, 197. Data is reported for days where samples were collected for each participant. |
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