HIV Infections Clinical Trial
Official title:
Structured Treatment Interruption as an Autovaccination Approach to Enhance Immune Based HIV-1 Control in an Adolescent/Young Adult Population
This study will attempt to stimulate the immune system in HIV infected adolescents and young adults so that it can better control the HIV infection. When anti-HIV drugs are stopped for a period of time, the virus "grows back." This may stimulate the immune system, which may then be more effective in controlling the virus.
The focus of this study is to use Structured Treatment Interruption (STI) as an approach to
auto-immunization. The STI management schema is based on current understanding of HIV-1
viral dynamics, pharmacology of available antiretroviral medications, and HIV-specific host
responses. This is a Phase II trial to provide preliminary data on the feasibility and
possible efficacy of using STI to enhance immune-based control of HIV-1 replication. A
steady state HIV-1 viral load determined from historical tests prior to initiating highly
active antiretroviral therapy (HAART) will be compared to the steady state viral load
post-STI. HIV-1 specific CD4 and CD8 cell responses will be measured before and after the
period of STI management and HIV-1 specific CD8 cell maturational phenotype will be assessed
and correlated with ability to control viral replication.
Adolescents and young adults who have either had sustained viral suppression on HAART for at
least 2 years or who have had sustained viral suppression from 3 to 6 months will be
eligible for this study. Participants will have 12 weeks of HAART followed by 2 to 4 weeks
of treatment interruption. Participants will undergo three rounds of this regimen. After the
third STI, participants will have an additional 12 weeks of HAART and then stop therapy.
Participants will be monitored off HAART for up to 20 weeks. During this time, if there is
evidence of HIV progression (two consecutive viral loads exceeding 10,000 copies/ml; two
consecutive CD4 cell counts under 350 cells/microL; two consecutive CD4 percentages less
than 15%; or two consecutive CD4 cell counts less than 50% of baseline), standard continuous
antiretroviral therapy will be reinstituted. Plasma HIV RNA will be tested monthly during
therapy and weekly while subjects are off treatment. Immunologic studies are monthly
throughout the study. Participants will be involved in the study for approximately 2 years.
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