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Chloroquine for Reducing Immune Activation in HIV- Infected Individuals

2014年10月3日 更新者:AIDS Clinical Trials Group

A Phase II, Double Blind, Randomized, Exploratory Study of Chloroquine for Reducing HIV-Associated Immune Activation

HIV is characterized by frequent immune system activation. Early in the course of infection the body establishes an immune activation "set point" related to the amount of HIV in the blood stream. This set point affects the rate of CD4 cell loss. Without CD4 cells, or with very low levels of CD4 cells, the body cannot fight off illness. This is known as immunodeficiency. If left untreated HIV can lead to extreme immunodeficiency and AIDS.

Evidence suggests that by decreasing the rate of immune system activation, immune deficiency progression could be prevented. The purpose of this study is to learn how well chloroquine can reduce the level of immune activation and to test the safety and tolerance of chloroquine in people infected with HIV.

研究概览

详细说明

HIV is characterized by persistent immune system activation, and early in the course of infection the body establishes an immune activation "set point" related to the amount of HIV in the blood stream. This set point affects the rate of CD4 cell loss. Without CD4 cells, or with very low levels of CD4 cells, the body cannot fight off illness. This is known as immunodeficiency. If left untreated HIV can lead to extreme immunodeficiency and AIDS.

Immune system activation includes activating the CD8 cells. These cells attack body cells infected with viruses. Because of this, CD4 cells infected with HIV are frequently destroyed by CD8 cells. The purpose of this study is to learn how well chloroquine reduces the level of activation of CD8 cells in people infected with HIV. Increased activation of CD8 cells is thought to lead to a more severe path of disease in HIV infection.

The constant immune activation observed in HIV- infected patients has also been linked to higher levels of byproducts from certain naturally occurring bacteria found in the gut that are known to be immune stimulants. By decreasing the stimulation from these byproducts with chloroquine treatment, HIV disease may be slowed.

The purpose of this study was to learn how well chloroquine reduces the level of activation of CD8 cells and lowers the levels of bacteria byproducts in people infected with HIV, either off antiretroviral therapy (ART) (protocol version 1.0 dated December 17, 2008) or on-ART (protocol version 2.0 dated October 1, 2010). The off-ART (Arms A and B) and on-ART (Arms C and D) participants were enrolled during different time periods, and the study was designed to analyze the two study populations separately. This study also looked at how well chloroquine was tolerated and its safety in HIV- infected participants.

Off-ART participants in the study were randomized with equal probability to one of two treatment arms:

Arm A: Participants received 12 weeks of chloroquine treatment followed by 12 weeks of placebo

Arm B: Participants received 12 weeks of placebo followed by 12 weeks of chloroquine

On-ART participants in the study were randomized with equal probability to one of two treatment arms:

Arm C: Participants received 12 weeks of chloroquine treatment followed by 12 weeks of placebo

Arm D: Participants received 12 weeks of placebo followed by 12 weeks of chloroquine

Study treatment was given once a day for a full 24 weeks. There was an additional 4 weeks of follow-up for purposes of safety. After treatment has started, participants were asked to come to the clinic on Weeks 4, 10, 12, 16, 22, and 24. At each visit participants were given enough study treatment to last until the next visit. Each visit lasted between 30 and 60 minutes. At most visits, participants had a physical exam, answered questions about any medications they were taking and how they are feeling, and had blood drawn for safety to assess CD4/CD8 cell counts and viral load. Some additional blood were also stored for immunology testing. At some visits, participants were asked questions about their medication and medical history, had pupils dilated, had a hearing test, and had an electrocardiogram (EKG). Some visits required participants to arrive fasting. Pregnancy tests were also conducted if the participant is able to become pregnant or if pregnancy was suspected.

研究类型

介入性

注册 (实际的)

70

阶段

  • 阶段2

联系人和位置

本节提供了进行研究的人员的详细联系信息,以及有关进行该研究的地点的信息。

学习地点

    • Alabama
      • Birmingham、Alabama、美国、35294
        • Alabama Therapeutics CRS (5801)
    • California
      • San Diego、California、美国、92103
        • Ucsd, Avrc Crs (701)
    • Colorado
      • Aurora、Colorado、美国、80045
        • University of Colorado Hospital CRS (6101)
    • District of Columbia
      • Washington、District of Columbia、美国、20007
        • Georgetown University CRS (GU CRS) (1008)
    • Maryland
      • Baltimore、Maryland、美国、21205
        • Johns Hopkins Adult AIDS CRS (201)
    • Massachusetts
      • Boston、Massachusetts、美国、02114
        • Massachusetts General Hospital ACTG CRS (101)
    • Missouri
      • St. Louis、Missouri、美国、63110
        • Washington University CRS (2101)
    • New York
      • New York、New York、美国、10011
        • Cornell CRS (7804)
    • North Carolina
      • Chapel Hill、North Carolina、美国、27514
        • Unc Aids Crs (3201)
    • Ohio
      • Cincinnati、Ohio、美国、45267
        • Univ. of Cincinnati CRS (2401)
      • Cleveland、Ohio、美国、44106
        • Case CRS (2501)
      • Cleveland、Ohio、美国、44109
        • MetroHealth CRS (2503)
    • Pennsylvania
      • Philadelphia、Pennsylvania、美国、19104
        • Hosp. of the Univ. of Pennsylvania CRS (6201)
      • Pittsburgh、Pennsylvania、美国、15213
        • Pittsburgh CRS (1001)
    • Tennessee
      • Nashville、Tennessee、美国、37204
        • Vanderbilt Therapeutics CRS (3652)

参与标准

研究人员寻找符合特定描述的人,称为资格标准。这些标准的一些例子是一个人的一般健康状况或先前的治疗。

资格标准

适合学习的年龄

18年 及以上 (成人、年长者)

接受健康志愿者

有资格学习的性别

全部

描述

Inclusion Criteria:

  • HIV-1 infected
  • Certain specified laboratory values obtained within 30 days prior to study entry. More information on this criterion can be found in the study protocol.
  • Documentation that pre-entry specimen for the primary immune activation endpoint responses has been obtained
  • Female participants of reproductive potential must have a negative pregnancy test performed within 24 hours prior to study entry
  • If engaging in sexual activity, female participants must use adequate forms of contraception while receiving study treatment and for 4 weeks after stopping the treatment. More information on this criterion can be found in the study protocol.
  • Ability and willingness to provide informed consent

Additional Inclusion Criteria for Off-ART Participants:

  • No antiretroviral therapy (ART) for at least 6 months prior to study entry and not likely to start within the 6 months after study entry
  • CD4 cell count greater than or equal to 400 cells/mm3 at screening, obtained within 30 days prior to study entry
  • For participants with previous ART use, documentation or recall of nadir CD4 cell count greater than or equal to 200 cells/mm3
  • HIV-1 RNA viral load greater than or equal to 1,000 copies/mL obtained within 30 days prior to study entry
  • No history of CDC category C AIDS-related opportunistic infections
  • Karnofsky performance score greater than or equal to 70 within 30 days prior to study entry

Additional Inclusion Criteria for On-ART Participants:

  • Receiving ART, defined as a regimen that includes three or more antiretroviral medications, for at least 24 months prior to study entry
  • Required documentation that all HIV-1 viral loads (at least two) were below 400 copies/mL. More information on this criterion can be found in the study protocol.
  • Screening HIV-1 RNA <200 copies/mL within 30 days prior to study entry. More information on this criterion can be found in the study protocol.
  • CD4 cell count <350 cells/mm3 at screening, obtained within 30 days prior to study entry

Exclusion Criteria:

  • Continuous use of certain specified medication for more than 3 days within 30 days prior to study entry. More information on this criterion can be found in the study protocol.
  • Use of chloroquine or hydroxychloroquine within 3 months prior to study entry
  • Known history of hypersensitivity to 4-aminoquinoline compounds (such as chloroquine or hydroxychloroquine)
  • Active drug or alcohol use or dependence that, in the opinion of the investigator would interfere with adherence to study requirements
  • Serious illness requiring systemic treatment and/or hospitalization within 30 days prior to study entry
  • Renal insufficiency, defined as serum creatinine greater than 1.5 mg/dL, within 30 days prior to study entry
  • History of retinal disease (i.e. confirmed retinopathy by ophthalmologic examination)
  • History of neoplasm, within 5 years prior to study entry, other than treated in situ carcinoma or basal-cell or localized squamous cell carcinoma of the skin
  • Glucose-6-phosphate dehydrogenase (G6PD) deficiency at screening
  • History of porphyria
  • History of psoriasis
  • History of cirrhosis
  • History of seizure disorder
  • History of tinnitus (ear and/or head noise lasting more than 5 minutes that occurs more often than once per week) or history of sudden hearing loss
  • History of myopathy
  • History of cardiac conduction abnormality or cardiomyopathy. More information on this criterion can be found in the study protocol.

Additional Exclusion Criteria for On-ART Participants:

- Plans to change ART regimen with the 6 months after study entry (change in ART regimen is only permitted if due to toxicity)

学习计划

本节提供研究计划的详细信息,包括研究的设计方式和研究的衡量标准。

研究是如何设计的?

设计细节

  • 主要用途:治疗
  • 分配:随机化
  • 介入模型:交叉作业
  • 屏蔽:四人间

武器和干预

参与者组/臂
干预/治疗
实验性的:A: Chloroquine then Placebo for Off-ART Participants
Participants received chloroquine treatment from Day 0 through the Week 12 study visit and then began chloroquine placebo treatment until the Week 24 study visit.
Taken orally, once daily, at a dose of 250 mg for 12 weeks.
Taken orally, once daily for 12 weeks.
实验性的:B: Placebo then Chloroquine for Off-ART Participants
Participants received chloroquine placebo treatment from Day 0 through the Week 12 study visit and then began chloroquine treatment until the Week 24 study visit.
Taken orally, once daily, at a dose of 250 mg for 12 weeks.
Taken orally, once daily for 12 weeks.
实验性的:C: Chloroquine then Placebo for On-ART Participants
Participants received chloroquine treatment from Day 0 through the Week 12 study visit and then began chloroquine placebo treatment until the Week 24 study visit.
Taken orally, once daily, at a dose of 250 mg for 12 weeks.
Taken orally, once daily for 12 weeks.
实验性的:D: Placebo then Chloroquine for On-ART Participants
Participants received chloroquine placebo treatment from Day 0 through the Week 12 study visit and then began chloroquine treatment until the Week 24 study visit.
Taken orally, once daily, at a dose of 250 mg for 12 weeks.
Taken orally, once daily for 12 weeks.

研究衡量的是什么?

主要结果指标

结果测量
措施说明
大体时间
Change in Percent CD8 HLA-DR+/CD38+ From Baseline to Week 12
大体时间:At pre-entry, entry, weeks 10 and 12
The baseline percent CD8 HLA-DR+/CD38+ (mean of pre-entry and entry percent CD8 HLA-DR+/CD38+) was subtracted from the mean of week 10 and week 12 percent CD8 HLA-DR+/CD38+.
At pre-entry, entry, weeks 10 and 12

次要结果测量

结果测量
措施说明
大体时间
Change in Percent CD8 HLA-DR+/CD38+ From Start to End of the 12-week Chloroquine Treatment Period
大体时间:For Arms A and C: Pre-entry, entry, weeks 10 and 12. For Arms B and D: Weeks 10, 12, 22 and 24
For Arm A: Chloroquine then Placebo for off-ART participants and Arm C: Chloroquine then Placebo for on-ART participants, the baseline percent CD8 HLA-DR+/CD38+ (mean of pre-entry and entry percent CD8 HLA-DR+/CD38+) was subtracted from the mean of week 10 and week 12 percent CD8 HLA-DR+/CD38+. For Arm B: Placebo then Chloroquine for off-ART participants and Arm D: Placebo then Chloroquine for on-ART participants, the mean of week 10 and week 12 percent CD8 HLA-DR+/CD38+ was subtracted from the mean of week 22 and week 24 percent CD8 HLA-DR+/CD38+.
For Arms A and C: Pre-entry, entry, weeks 10 and 12. For Arms B and D: Weeks 10, 12, 22 and 24
Change in Percent CD8 HLA-DR+/CD38+ From Week 12 to Week 24
大体时间:At Weeks 10, 12, 22 and 24
The mean of week 10 and week 12 percent CD8 HLA-DR+/CD38+ is subtracted from the mean of the week 22 and week 24 percent CD8 HLA-DR+/CD38+
At Weeks 10, 12, 22 and 24
Change in Percent CD8 HLA-DR+/CD38+ From Baseline to Week 24 in Arm A and Arm C
大体时间:At Pre-entry, entry, Weeks 22 and 24
The baseline percent CD8 HLA-DR+/CD38+ (mean of pre-entry and entry percent CD8 HLA-DR+/CD38+) was subtracted from the mean of week 22 and week 24 percent CD8 HLA-DR+/CD38+.
At Pre-entry, entry, Weeks 22 and 24
Change in Total CD4 T Cell Count From Baseline to Week 12
大体时间:At pre-entry, entry, weeks 10 and 12
Baseline CD4 count (mean of pre-entry and entry CD4 count) is subtracted from the mean of week 10 and week 12 CD4 count
At pre-entry, entry, weeks 10 and 12
Number of Participants With Events Grade 3 or Higher
大体时间:From start of study treatment to study completion at week 28
Events included signs and symptoms, laboratory abnormalities and/or clinical events grade 3 or higher which were described by site clinician blinded to the treatment arm as definitely or possibly related to the study treatment.
From start of study treatment to study completion at week 28
HIV-1 RNA Copies/mL at Study Entry for Off-ART Participants
大体时间:At Entry
Results reported are for HIV-1 RNA (copies/mL) at study entry for off-ART participants.
At Entry
HIV-1 RNA Copies/mL at Weeks 12 and 24 for Off-ART Participants
大体时间:At weeks 12 and 24
Results reported are for HIV-1 RNA (copies/mL) at week 12 and week 24 for off-ART participants.
At weeks 12 and 24
HIV-1 RNA Copies/mL at Study Entry for On-ART Participants
大体时间:At Entry
Results reported are for HIV-1 RNA at study entry for on-ART participants.
At Entry
HIV-1 RNA Copies/mL at Week 12 for On-ART Participants
大体时间:At week 12
Results reported are for HIV-1 RNA at week 12 for on-ART participants.
At week 12
HIV-1 RNA Copies/mL at Week 24 for On-ART Participants
大体时间:At week 24
Results reported are for HIV-1 RNA at week 24 for on-ART participants.
At week 24
Percent CD8 CD38+ at Baseline
大体时间:At pre-entry and entry
Baseline CD8 CD38+ is computed as the mean of pre-entry and entry CD8 CD38+.
At pre-entry and entry
Percent CD8 CD38+ at Week 12
大体时间:At Week 12
Results reported are the week 12 percentage of CD8 expressing CD38+.
At Week 12
Percent CD8 CD38+ at Week 24
大体时间:At Week 24
Results reported are the week 24 percentage of CD8 expressing CD38+.
At Week 24
Percent CD4 HLA-DR+/CD38+ at Baseline
大体时间:At pre-entry and entry
Baseline CD4 HLA-DR+/CD38+ is computed as the mean of pre-entry and entry CD4 HLA-DR+/CD38+.
At pre-entry and entry
Percent CD4 HLA-DR+/CD38+ at Week 12
大体时间:At Week 12
Results reported are the week 12 percentage of CD4 expressing HLA-DR+/CD38+.
At Week 12
Percent CD4 HLA-DR+/CD38+ at Week 24
大体时间:At Week 24
Results reported are the week 24 percentage of CD4 expressing HLA-DR+/CD38+.
At Week 24
IL-6, Soluble TNF-rI (sTNF-rI) and D-dimer at Baseline
大体时间:At pre-entry and entry
Baseline IL-6, sTNF-rI and D-dimer were computed as the mean of pre-entry and entry IL-6, sTNF-rI and D-dimer, respectively.
At pre-entry and entry
IL-6, Soluble TNF-rI (sTNF-rI) and D-dimer at Week 12
大体时间:At week 12
Results reported are the week 12 IL-6, sTNF-rI and D-dimer.
At week 12
IL-6, Soluble TNF-rI (sTNF-rI) and D-dimer at Week 24
大体时间:At week 24
Results reported are the week 24 IL-6, sTNF-rI and D-dimer.
At week 24
Soluble CD14 (sCD14) at Baseline
大体时间:At pre-entry and entry
Baseline sCD14 was computed as the mean of pre-entry and entry sCD14.
At pre-entry and entry
Soluble CD14 (sCD14) at Week 12
大体时间:At week 12
Results reported are the week 12 sCD14.
At week 12
Soluble CD14 (sCD14) at Week 24
大体时间:At week 24
Results reported are the week 24 sCD14.
At week 24
Fasting Lipopolysaccharides (LPS) at Entry
大体时间:At entry
Results reported are for entry fasting LPS.
At entry
Fasting Lipopolysaccharides (LPS) at Week 12
大体时间:At week 12
Results reported are the week 12 fasting LPS.
At week 12
Fasting Lipopolysaccharides (LPS) at Week 24
大体时间:At week 24
Results reported are the week 24 fasting LPS.
At week 24
Percent Activation Levels of Plasmacytoid Dendritic Cells (pDC) and Myeloid Dendritic Cells (mDC) at Baseline
大体时间:At pre-entry and entry
Baseline percent activation levels of pDC were computed as the mean of pre-entry and entry percent activation levels of pDC. Similarly, baseline percent activation levels of mDC were computed as the mean of pre-entry and entry percent activation levels of mDC.
At pre-entry and entry
Percent Activation Levels of Plasmacytoid Dendritic Cells (pDC) and Myeloid Dendritic Cells (mDC) at Week 12
大体时间:At week 12
Results reported are the week 12 percent activation levels of pDC and mDC.
At week 12
Percent Activation Levels of Plasmacytoid Dendritic Cells (pDC) and Myeloid Dendritic Cells (mDC) at Week 24
大体时间:At week 24
Results reported are the week 24 percent activation levels of pDC and mDC.
At week 24

合作者和调查者

在这里您可以找到参与这项研究的人员和组织。

调查人员

  • 学习椅:Jeffrey M Jacobson, MD、Drexel University College of Medicine

出版物和有用的链接

负责输入研究信息的人员自愿提供这些出版物。这些可能与研究有关。

研究记录日期

这些日期跟踪向 ClinicalTrials.gov 提交研究记录和摘要结果的进度。研究记录和报告的结果由国家医学图书馆 (NLM) 审查,以确保它们在发布到公共网站之前符合特定的质量控制标准。

研究主要日期

学习开始

2009年3月1日

初级完成 (实际的)

2013年2月1日

研究完成 (实际的)

2013年5月1日

研究注册日期

首次提交

2009年1月8日

首先提交符合 QC 标准的

2009年1月8日

首次发布 (估计)

2009年1月9日

研究记录更新

最后更新发布 (估计)

2014年10月13日

上次提交的符合 QC 标准的更新

2014年10月3日

最后验证

2014年10月1日

更多信息

此信息直接从 clinicaltrials.gov 网站检索,没有任何更改。如果您有任何更改、删除或更新研究详细信息的请求,请联系 register@clinicaltrials.gov. clinicaltrials.gov 上实施更改,我们的网站上也会自动更新.

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