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Antiretroviral Localization in Gut-Associated Lymphoid Tissue and Lower Female Genital Tract Tissue of HIV+ Subjects

12 janvier 2018 mis à jour par: Angela Kashuba, PharmD, University of North Carolina, Chapel Hill
The purpose of this research study is to find out how the drugs Truvada® (tenofovir/emtricitabine), Isentress® (raltegravir), Reyataz® (atazanavir), Sustiva® (efavirenz), and Selzentry® (maraviroc) get into the intestines and the female genital tract. All of these drugs are very effective at reducing the number of HIV viruses in the blood, however it is unknown how the drugs move around inside tissues where HIV might be hiding. This study will determine specifically where in the tissue the drug and the HIV are located through the use of a new technology that takes creates a picture of the tissue. This information will help scientists determine the best way to make new drugs to target the hidden HIV in tissue.

Aperçu de l'étude

Description détaillée

Study Design

This is an observational study of TFV, FTC, RAL, ATZ, EFV, and MVC localization within GALT (terminal ileum & rectum), vaginal, and cervical tissues in the setting of undetectable plasma HIV. Participants will be selected on the basis of receiving either TFV/FTC/RAL, TFV/FTC/ATZ/r, TFV/FTC/EFV, or TFV/FTC/MVC as part of their ongoing HIV care. After participant education, informed consent, and screening for study eligibility, participants will be evaluated at baseline. All samples will be collected over the course of a 36 hour inpatient visit as described below.

Study Sampling

  1. Blood plasma will be collected after enrollment (approximately 2 hours after the start of the inpatient visit) and before the start of bowel preparation (approximately 2-12 hours after the start of the inpatient visit).
  2. Vaginal and cervical tissue will be collected after enrollment (approximately 2 hours after the start of the inpatient visit) and before the start of bowel preparation (approximately 2-12 hours after the start of the inpatient visit).
  3. Rectal and terminal ileal tissue will be collected at approximately 18 hours after the initiation of the bowel preparation.

Pharmacokinetic Analysis All blood, cervical, vaginal, ileal and rectal tissue samples will be analyzed by the Clinical Pharmacology and Analytical Chemistry Laboratory (CPAC) at the UNC School of Pharmacy, which is directed by the principal investigator, Angela Kashuba, PharmD. To visualize ARV localization within a tissue, one biopsy from each tissue site will be analyzed by IR-MALDESI using a previously established workflow for our laboratory.

HIV localization within tissues will be performed using in situ hybridization (ISH) in collaboration with the Haase lab at the University of Minnesota. This group has substantial experience in HIV RNA detection from human tissues, and preliminary studies have confirmed our ability to detect HIV RNA from serial slices of tissues.

Localization within tissue slices will be evaluated by IR-MALDESI. Measurement of the distribution of each ARV within pre-specified anatomical sub-regions across a tissue slice will allow for identification of areas where drug is either concentrating or lacking. ISH and IHC analysis of serial tissue slices will allow us to co-localize ARVs with HIV and HIV target cells. Once these anatomical areas have been visually identified, imaging software will be used to isolate and quantify the signal.

Type d'étude

Observationnel

Inscription (Réel)

5

Contacts et emplacements

Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.

Lieux d'étude

    • North Carolina
      • Chapel Hill, North Carolina, États-Unis, 27514
        • University of North Carolina at Chapel Hill

Critères de participation

Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.

Critère d'éligibilité

Âges éligibles pour étudier

18 ans à 65 ans (Adulte, Adulte plus âgé)

Accepte les volontaires sains

Non

Sexes éligibles pour l'étude

Femelle

Méthode d'échantillonnage

Échantillon non probabiliste

Population étudiée

This study will consist of 22 HIV positive women between 18-65 years of age (inclusive) with an intact gastrointestinal tract, uterus and cervix who are available to complete all study procedures at UNC.

La description

Inclusion Criteria:

  1. Healthy HIV-positive female subjects between the ages of 18 and 65 years, inclusive on the date of screening, with an intact gastrointestinal tract, uterus, and cervix. Healthy is defined as no clinically relevant abnormalities that would interfere with the interpretation of results, or pose unnecessary risk onto volunteers due to study procedures.
  2. All subjects must have an undetectable viral load at the time of screening or a documented undetectable viral load within the preceding 3 months of screening.
  3. All subjects must be receiving one of the study regimens as part of their regular HIV care for at least 6 months preceding the date of enrollment.
  4. Subjects must not have a history of GI disease (e.g. Crohn's disease, irritable bowel syndrome, ulcerative colitis, diverticulitis, colon cancer) or have a history of GI surgery.
  5. All subjects (of childbearing potential) must have a negative serum pregnancy test at screening and negative urine pregnancy tests on days of sampling and should be using at least one of the following methods of contraception from the screening visit through 72 hours prior to inpatient admission (at which time the women will be asked to remain abstinent until after their follow-up visit):

    1. Systemic hormonal contraceptive (oral, depot, transdermal or implant)
    2. IUD placed at least 1 month prior to study enrollment
    3. Bilateral tubal ligation (Sterilization)
    4. Vasectomized male partners
    5. Condom + Spermicide
    6. Engaged in sexual activity with female only sex partners or abstinent for at least 3 months prior with no intention of becoming sexually active during the study period. Any history of recent or present concomitant male sex partners will be addressed and ruled out in the context of screening participants for eligibility for the protocol
  6. Body Mass Index (BMI) of approximately 18 to 37 kg/m2; and a total body weight > 45 kg (99 lbs).
  7. Evidence of a personally signed and dated informed consent document indicating that the subject has been informed of all pertinent aspects of the trial.
  8. Willing and able to comply with scheduled visits, treatment plan, laboratory tests, and other trial procedures.
  9. Subject must have documentation of a normal pap smear within 36 months of the screening visit, no procedures for abnormal cervical/vaginal pathology in the last six months, at least one prior gynecological visit as part of subject's routine medical history.
  10. Not receiving any known CYP3A4 inducers (rifampin, carbamazepine, St. John's wort) or inhibitors (ketoconazole, non-DHP calcium channel blockers, macrolide antibiotics) other than those contained in their HIV regimen for at least 6 months prior to enrollment.
  11. Subject must be willing to abstain from sexual intercourse, douching, and all intravaginal and intrarectal objects and products for at least 72 hours prior to enrollment until study completion.
  12. Subject must be Hepatitis B surface antigen negative as documented on screening labs (or documented in their clinical record).
  13. Subject must not be actively involved in the conception process.
  14. Subject must be able to swallow pills and have no allergies to any component of the study products (i.e. bowel preparation regimen)

Exclusion Criteria

  1. Evidence or history of clinically significant hematological, renal, endocrine, pulmonary, gastrointestinal, cardiovascular, hepatic, psychiatric, neurologic, or allergic disease (including documented drug allergies, but excluding untreated, asymptomatic, seasonal allergies at time of dosing).
  2. Subjects with a history of hysterectomy or cervical resection that would preclude obtaining a cervical biopsy.
  3. Subjects who are pregnant, possibly pregnant or lactating.
  4. Subjects with a presence of abnormal vaginal discharge bleeding at screening.
  5. History of febrile illness within five days prior to enrollment.
  6. A positive urine drug screen for illicit substances (e.g. cocaine, methamphetamines) that would increase risk associated with sedation.
  7. Active Hepatitis B infection
  8. An untreated-positive test for syphilis, gonorrhea, Chlamydia, or trichomonas at screening. Tests for these STIs will be performed on samples from both the vaginal and rectal orifices.
  9. Any clinically significant laboratory chemistry or hematology result Grade 3 or greater according to the DAIDS Laboratory Grading Tables
  10. Treatment with an investigational drug within 4 months preceding the first dose of trial medication.
  11. History of regular alcohol consumption exceeding 14 drinks (1 drink = 5 ounces (150 mL) of wine or 12 ounces (360 mL) of beer or 1.5 ounces (45 mL) of spirits) per week.
  12. Participation in a clinical trial involving genital tract or rectal biopsies within 6 months preceding enrollment.
  13. Blood donation of approximately 1 pint (500 mL) within 56 days prior to dosing.
  14. History of sensitivity to heparin or heparin-induced thrombocytopenia.
  15. Allergy to lidocaine or Monsel's solution.
  16. Allergy to latex.
  17. Abnormal pap smear in the past 36 months
  18. Any degree of ectopy or abnormality evident during the pelvic exam at screening.
  19. Any condition which, in the opinion of the investigator, is likely to interfere with follow-up or ability to take the bowel preparation appropriately.
  20. Unwilling or unable to comply with the dietary and concomitant drug restrictions in regard to study drug administration as outlined in the study procedures and prohibited medications sections.

Plan d'étude

Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.

Comment l'étude est-elle conçue ?

Détails de conception

Cohortes et interventions

Groupe / Cohorte
Intervention / Traitement
Efavirenz
Receiving efavirenz as part of their HIV regimen. Will undergo blood plasma collection, cervical and vaginal biopsy, and colonoscopy with ileal and rectal biopsy.
Approximately 3mL of blood will be taken from each subject just prior to the colonoscopy.
2 biopsies each will be collected from the vaginal wall and the cervix
10 biopsies each will be collected from the rectum and terminal ileum from each subject during the colonoscopy.
Atazanavir
Receiving atazanavir as part of their HIV regimen. Will undergo blood plasma collection, cervical and vaginal biopsy, and colonoscopy with ileal and rectal biopsy.
Approximately 3mL of blood will be taken from each subject just prior to the colonoscopy.
2 biopsies each will be collected from the vaginal wall and the cervix
10 biopsies each will be collected from the rectum and terminal ileum from each subject during the colonoscopy.
Raltegravir
Receiving raltegravir as part of their HIV regimen. Will undergo blood plasma collection, cervical and vaginal biopsy, and colonoscopy with ileal and rectal biopsy.
Approximately 3mL of blood will be taken from each subject just prior to the colonoscopy.
2 biopsies each will be collected from the vaginal wall and the cervix
10 biopsies each will be collected from the rectum and terminal ileum from each subject during the colonoscopy.
Maraviroc
Receiving maraviroc as part of their HIV regimen. Will undergo blood plasma collection, cervical and vaginal biopsy, and colonoscopy with ileal and rectal biopsy.
Approximately 3mL of blood will be taken from each subject just prior to the colonoscopy.
2 biopsies each will be collected from the vaginal wall and the cervix
10 biopsies each will be collected from the rectum and terminal ileum from each subject during the colonoscopy.

Que mesure l'étude ?

Principaux critères de jugement

Mesure des résultats
Description de la mesure
Délai
Antiretroviral tissue localization
Délai: Samples collected within 24 hours post-dose
Tissues collected during inpatient stay will be frozen for later analysis (i.e. MSI-derived images of TFV, FTC, RAL, ATZ, EFV, and MVC localization within tissue slices.) to be completed within 6 months of tissue collection.
Samples collected within 24 hours post-dose

Mesures de résultats secondaires

Mesure des résultats
Description de la mesure
Délai
Quantitation of antiretroviral tissue concentrations by LC-MS/MS
Délai: Samples collected within 24 hours post-dose
Tissues collected during inpatient stay will be frozen for later analysis (i.e. TFV, FTC, RAL, ATZ , EFV, and MVC concentrations in tissues as determined by LC-MS/MS) to be completed within 6 months of tissue collection.
Samples collected within 24 hours post-dose
Immunohistochemical images of CD3, CD4, and CD8 distribution within tissue slices
Délai: Samples collected within 24 hours post-dose
Tissues collected during inpatient stay will be frozen for later analysis (i.e. IHC staining for localization of HIV target cells within serial slices of tissue) to be completed within 6 months of tissue collection.
Samples collected within 24 hours post-dose
in-situ hybridization images of HIV RNA distribution within tissue slices
Délai: Samples collected within 24 hours post-dose
Tissues collected during inpatient stay will be frozen for later analysis (i.e. ISH staining for localization of HIV RNA within serial slices of tissue) to be completed within 6 months of tissue collection.
Samples collected within 24 hours post-dose
Quantification of antiretroviral tissue concentrations by MSI
Délai: Samples collected within 24 hours post-dose
Tissues collected during inpatient stay will be frozen for later analysis (i.e. TFV, FTC, RAL, ATZ , EFV, and MVC concentrations in tissues as determined by MSI) to be completed within 6 months of tissue collection.
Samples collected within 24 hours post-dose

Collaborateurs et enquêteurs

C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.

Les enquêteurs

  • Chercheur principal: Angela DM Kashuba, PharmD, University of North Carolina, Chapel Hill

Publications et liens utiles

La personne responsable de la saisie des informations sur l'étude fournit volontairement ces publications. Il peut s'agir de tout ce qui concerne l'étude.

Dates d'enregistrement des études

Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.

Dates principales de l'étude

Début de l'étude (Réel)

13 avril 2016

Achèvement primaire (Réel)

29 août 2017

Achèvement de l'étude (Réel)

29 août 2017

Dates d'inscription aux études

Première soumission

17 décembre 2015

Première soumission répondant aux critères de contrôle qualité

22 décembre 2015

Première publication (Estimation)

29 décembre 2015

Mises à jour des dossiers d'étude

Dernière mise à jour publiée (Réel)

17 janvier 2018

Dernière mise à jour soumise répondant aux critères de contrôle qualité

12 janvier 2018

Dernière vérification

1 avril 2017

Plus d'information

Termes liés à cette étude

Autres numéros d'identification d'étude

  • 15-2865

Plan pour les données individuelles des participants (IPD)

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