- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04787848
Chronic Widespread Pain in HIV: Novel Mechanisms and Therapeutics
November 6, 2023 updated by: Saurabh Aggarwal, University of Alabama at Birmingham
Role of Endogenous Opioid Peptides in HIV-associated Chronic Widespread Pain
To determine if decreased production or release of endogenous opioid peptides by peripheral immune cells contributes to hypersensitivity in people with HIV
Study Overview
Status
Recruiting
Conditions
Intervention / Treatment
Detailed Description
The prevalence of chronic widespread pain (CWP) in individuals infected with the human immunodeficiency virus (HIV-1) includes regional and widespread musculoskeletal pain of neuropathic and inflammatory nature.
HIV-related CWP leads to 10x greater odds of functional impairment.
However, the specific mechanisms that contribute to CWP in HIV are not understood.
Thus, pharmacological and non-pharmacological approaches to mitigate CWP have had minimal benefits, contributing to an overreliance on opioids and alarming rise in addiction and overdose.
The overall objective of this study is to address the gap in the knowledge of the pathogenesis of HIV-related CWP.
Specifically, the role of impaired endogenous opioid synthesis/release from leukocytes in people with HIV (PWH) who self-report CWP will be explored.
Leukocytes (neutrophils, monocytes/macrophages, and lymphocytes) are a rich source of opioid peptides (Met-enkephalin, dynorphin A, β-endorphin) that inhibit nociception by binding to peripheral opioid receptors.
Therefore, to establish whether decreased peripheral opioid peptides correlate with experimental pain measures in PWH with self-reported CWP, quantitative sensory testing (QST) will be completed before and after administration of methylnaltrexone bromide (RELISTOR), a clinically available, peripherally acting opioid receptor antagonist.
Study Type
Interventional
Enrollment (Estimated)
200
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Saurabh Aggarwal, MD., PhD
- Phone Number: 205-996-7134
- Email: saurabhaggarwal@uabmc.edu
Study Locations
-
-
Alabama
-
Birmingham, Alabama, United States, 35205
- Recruiting
- Clinical Research Unit at the University of Alabama at Birmingham
-
Contact:
- Joshua Vernon
- Phone Number: 205-934-6669
- Email: jsvernon@uab.edu
-
Principal Investigator:
- Saurabh Aggarwal, MD., PhD
-
Sub-Investigator:
- Burel Goodin, PhD
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
19 years to 65 years (Adult, Older Adult)
Accepts Healthy Volunteers
Yes
Description
Inclusion Criteria:
- Confirmed HIV diagnosis and currently a patient in the UAB 1917 HIV Clinic
- Age 19 - 65; the lower end of this age range was chosen to capture young adults with HIV infection, and participants over 65 years are increasingly likely to meet one or more exclusion criteria
- All people living with HIV must be currently receiving stable antiretroviral therapy (ART) for inclusion in this study
- Non-HIV participants must be confirmed as HIV negative. HIV-negative participants with chronic widespread pain must self-report bodily pain more than once per week for at least three consecutive months and HIV-negative participants without chronic pain must self-report no pain, or pain less frequently than once per week for at least three consecutive months
Exclusion Criteria:
- Anemia
- Current or past history of blood disorders which may increase hemolysis
- Active microbial infections which may alter the quantity or quality of blood inflammatory cells such as monocytes and neutrophils
- Use of certain medication other than antiretroviral therapy that might conflict with study observations. However, participants will not be excluded or asked to withdraw from medications used for pain management since temporary withdrawal from these medications could affect pain measures (exceptions will be therapies such as methadone or buprenorphine used to treat opioid addiction). Only those who are stable on these medications for at least 60 days will be included. All patient medications used for at least the 60 days prior to participation will be recorded and controlled in statistical analyses as needed
- Systemic rheumatic disease (e.g., rheumatoid arthritis, systemic lupus erythematosus). These rheumatologic conditions will be excluded due to their autoimmune characteristic. . Cachexia (wasting syndrome) and severe frailty. This exclusion is in place to protect against the stress of experimental pain testing
- A history of clinically significant surgery in the past year
- Uncontrolled hypertension (i.e. SBP/DBP of >150/95) or cardiovascular or peripheral arterial disease. These exclusions are in place primarily for safety reasons because the cold pressor task represents a cardiovascular challenge. However, uncontrolled hypertension can also affect pain perception, which is another reason for excluding these individuals
- Poorly controlled diabetes (HbA1c > 8%) for both safety reasons, and because diabetic neuropathy could alter pain perception
- Neurological disease (e.g. Parkinson's, multiple sclerosis, epilepsy)
- Serious psychiatric disorder requiring hospitalization within the past 12 months or characterized by active suicidal ideation
- Any participant deemed to be actively suicidal upon study screening will be escorted to the UAB emergency room and evaluated by the Psychiatry Service
- Diminished cognitive function that would interfere with understanding of study procedures. The Realm Health Literacy Test will be administered to ensure that participants are free of cognitive impairment that would compromise study participation
- Pregnancy. Inclusion/exclusion criteria will be verified using the screening tool in combination with review of participants' medical records
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Basic Science
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: HIV negative without chronic widespread pain
50 Participants will be randomly administered saline or RELISTOR (Individuals weighing 38-<62 kg will receive an 8 mg dose; those weighing 62-114 kg will receive a 12 mg dose; Participants weighing more than 114 kg will receive 0.15 mg/kg) in counterbalance between visit 1 and visit 2.
|
Relistor is a peripherally acting opioid receptor antagonist approved by the FDA for relief of opioid-induced constipation
Other Names:
|
Experimental: HIV negative with chronic widespread pain
50 Participants will be randomly administered saline or RELISTOR (Individuals weighing 38-<62 kg will receive an 8 mg dose; those weighing 62-114 kg will receive a 12 mg dose; Participants weighing more than 114 kg will receive 0.15 mg/kg) in counterbalance between visit 1 and visit 2.
|
Relistor is a peripherally acting opioid receptor antagonist approved by the FDA for relief of opioid-induced constipation
Other Names:
|
Experimental: HIV positive without chronic widespread pain
50 Participants will be randomly administered saline or RELISTOR (Individuals weighing 38-<62 kg will receive an 8 mg dose; those weighing 62-114 kg will receive a 12 mg dose; Participants weighing more than 114 kg will receive 0.15 mg/kg) in counterbalance between visit 1 and visit 2.
|
Relistor is a peripherally acting opioid receptor antagonist approved by the FDA for relief of opioid-induced constipation
Other Names:
|
Experimental: HIV positive with chronic widespread pain
50 Participants will be randomly administered saline or RELISTOR (Individuals weighing 38-<62 kg will receive an 8 mg dose; those weighing 62-114 kg will receive a 12 mg dose; Participants weighing more than 114 kg will receive 0.15 mg/kg) in counterbalance between visit 1 and visit 2.
|
Relistor is a peripherally acting opioid receptor antagonist approved by the FDA for relief of opioid-induced constipation
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Quantitative sensory testing (QST)
Time Frame: At baseline (study visit 1)
|
Measured at baseline and 30 min post intervention to assess change in response. (0=no pain, 100=most pain)
|
At baseline (study visit 1)
|
Quantitative sensory testing (QST)
Time Frame: Study visit 2 will occur at least 5-7 days after the first visit
|
Measured at baseline and 30 min post intervention to assess change in response. (0=no pain, 100=most pain)
|
Study visit 2 will occur at least 5-7 days after the first visit
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
McGill Pain Questionnaire-Short Form
Time Frame: At baseline (study visit 1)
|
15 descriptors (11 sensory; 4 affective) using an intensity scaled ranging from 0-3 on pain scale (0 = no pain, 1 = mild pain, 2 = moderate pain or 3 = severe pain)
|
At baseline (study visit 1)
|
McGill Pain Questionnaire-Short Form
Time Frame: Study visit 2 will occur at least 5-7 days after the first visit
|
15 descriptors (11 sensory; 4 affective) using an intensity scaled ranging from 0-3 on pain scale (0 = no pain, 1 = mild pain, 2 = moderate pain or 3 = severe pain)
|
Study visit 2 will occur at least 5-7 days after the first visit
|
Measuring endogenous opioid peptides in plasma and peripheral leukocytes
Time Frame: At baseline (study visit 1)
|
20 ml blood will be drawn to isolate plasma and peripheral leukocytes
|
At baseline (study visit 1)
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: Saurabh Aggarwal, MD., PhD, University of Alabama at Birmingham
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
November 15, 2021
Primary Completion (Estimated)
June 30, 2025
Study Completion (Estimated)
December 30, 2025
Study Registration Dates
First Submitted
February 25, 2021
First Submitted That Met QC Criteria
March 4, 2021
First Posted (Actual)
March 9, 2021
Study Record Updates
Last Update Posted (Estimated)
November 8, 2023
Last Update Submitted That Met QC Criteria
November 6, 2023
Last Verified
November 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 300007004
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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