The Use of Leukapheresis to Support HIV Pathogenesis Studies

Despite the dramatic improvements that have resulted from combination antiretroviral treatment, long-term efficacy, toxicity, cost, and the requirements for life-long adherence remain as formidable challenges. Also, there is emerging consensus that persistent HIV-associated disease occurs during long-term highly active antiretroviral therapy (HAART). This disease may be due to either direct drug-toxicity and/or persistent viral replication/production and/or persistent HIV-associated inflammation. Hence, strategies aimed at achieving complete viral eradication may be needed in order to fully restore health among HIV infected individuals. Even if complete eradication proves impossible-as most believe to be the case-a less rigorous but still desirable outcome might be achieving durable control of virus in the absence of therapy. That a "functional" cure is possible is well illustrated by those rare individuals who are able to durably control replication competent virus in the absence of therapy ("elite" controllers).

A more complete understanding of the relationship between inflammation and viral persistence is necessary before more rationale studies of HIV eradication can be designed. Also, a well validated high through-put virologic assay needs to be developed that can estimate the size of the latent reservoir. Since the level of replication competent virus in long-term treated patients (and in elite controllers) is very small (< 1% of CD4 cells harbor HIV), large numbers of CD4+ T cells most be obtained from study participants in order to routinely isolate and quantify virus persistence.

Study Overview

• Status: Recruiting
• Conditions: HIV
• Intervention / Treatment: Procedure: Leukapheresis

• Study Type: Observational
• Enrollment (Estimated): 100

Contacts and Locations

• Study Contact: Name: Steven Deeks, MD; Phone Number: 404 415-476-4082; Email: Steven.Deeks@ucsf.edu

Study Locations

• United States
  • California
    • San Francisco, California, United States, 94110
      • Recruiting
      • San Francisco General Hospital
      • Contact: Steven Deeks, MD; Phone Number: 404 415-476-4082; Email: Steven.Deeks@ucsf.edu
      • Principal Investigator: Steven Deeks, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

HIV-infected patients on long-term antiretroviral therapy, untreated patients, and elite controllers will be studied.

Description

Inclusion Criteria:

• HIV seropositive
• Able to give informed consent
• Willing to undergo blood sampling and/or leukapheresis
• Meeting one of the following criteria: (1) on stable highly active antiretroviral therapy (HAART) with a recent undetectable viral load (< 50 copies/mL) ("HAART suppressed"), (2) antiretroviral untreated with an undetectable viral load (< 50 copies/mL) ("elite" controllers) and (3) antiretroviral untreated with a detectable viral load (> 1000 copies/mL) ("non-controllers")

Exclusion Criteria:

• Known anemia (HIV+ males Hct<34; females Hct<32) or contraindication to donating blood
• Blood coagulation disorder (including bleeding tendency or problems in past with blood clots)
• Platelets < 50,000/mm3
• PTT > 2x ULN
• INR > 1.5
• Albumin < 2.0 g/dL
• ALT > 5x ULN
• AST > 5x ULN
• Biopsy-proven or clinical diagnosis of cirrhosis
• Weight <120 lb
• High blood pressure > 160/100
• Low blood pressure < 100/70
• Pregnant

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Untreated non-controllers	Procedure: Leukapheresis; Blood will be taken by a needle placed in one arm and processed through a machine, which spins the blood so that the white blood cells will be separated out in the machine for purposes of this research and the rest of the blood will be returned through a needle in the other arm.
Elite controllers	Procedure: Leukapheresis; Blood will be taken by a needle placed in one arm and processed through a machine, which spins the blood so that the white blood cells will be separated out in the machine for purposes of this research and the rest of the blood will be returned through a needle in the other arm.
HAART-suppressed	Procedure: Leukapheresis; Blood will be taken by a needle placed in one arm and processed through a machine, which spins the blood so that the white blood cells will be separated out in the machine for purposes of this research and the rest of the blood will be returned through a needle in the other arm.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
HIV DNA and RNA	Baseline and 6-12 months

Collaborators and Investigators

• Sponsor: University of California, San Francisco
• Investigators: Principal Investigator: Steven Deeks, MD, University of California, San Francisco

Study record dates

Study Major Dates

• Study Start (Actual): October 26, 2010
• Primary Completion (Estimated): July 1, 2033
• Study Completion (Estimated): July 1, 2033

Study Registration Dates

• First Submitted: July 9, 2010
• First Submitted That Met QC Criteria: July 12, 2010
• First Posted (Estimated): July 13, 2010

Study Record Updates

• Last Update Posted (Actual): May 30, 2023
• Last Update Submitted That Met QC Criteria: May 26, 2023
• Last Verified: May 1, 2023

More Information

Terms related to this study

• Keywords: HIV; functional cure; leukapheresis; latent reservoir
• Other Study ID Numbers: H52899-34904-01

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO