Imaging and Biopsy of HIV-Infected Individuals Undergoing Analytic Treatment Interruption
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ClinicalTrials.gov Identifier: NCT05419024 |
Recruitment Status :
Recruiting
First Posted : June 15, 2022
Last Update Posted : May 10, 2024
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Tracking Information | |||||
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First Submitted Date ICMJE | June 11, 2022 | ||||
First Posted Date ICMJE | June 15, 2022 | ||||
Last Update Posted Date | May 10, 2024 | ||||
Actual Study Start Date ICMJE | January 9, 2023 | ||||
Estimated Primary Completion Date | August 1, 2026 (Final data collection date for primary outcome measure) | ||||
Current Primary Outcome Measures ICMJE |
Proportion of participants who have a 3 fold increase in HIV RNA levels in tissue sites identified by imaging as having increased SUV on FDG-PET as defined below [ Time Frame: Up to day 90 ] To evaluate if changes in glucose metabolism (as measured by FDG PET SUV) correlate with changes in levels of HIV RNA in lymphoid tissue before and after ATI.
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Original Primary Outcome Measures ICMJE | Same as current | ||||
Change History | |||||
Current Secondary Outcome Measures ICMJE |
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Original Secondary Outcome Measures ICMJE |
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Current Other Pre-specified Outcome Measures | Not Provided | ||||
Original Other Pre-specified Outcome Measures | Not Provided | ||||
Descriptive Information | |||||
Brief Title ICMJE | Imaging and Biopsy of HIV-Infected Individuals Undergoing Analytic Treatment Interruption | ||||
Official Title ICMJE | Imaging and Biopsy of People With HIV-1 Undergoing Analytic Treatment Interruption | ||||
Brief Summary | Background: Human immunodeficiency virus (HIV) infects CD4 T cells. There is no cure for HIV. People with HIV need to take daily medications called antiretroviral therapy (ART) to control their infection. ART stops HIV from infecting cells, but HIV does not go away. Some infected cells remain. If ART is stopped, then HIV levels will rise and infect more cells. Objective: To find where HIV-infected cells are located in the body, even when ART is keeping levels low. Eligibility: Adults aged 18 years or older who are undergoing ART for HIV infection. Design: Participants will be screened with a physical exam, including blood tests. They will be assigned to 1 of 2 groups: One group will stay on ART. They will have 2 study visits: the first 45 days after screening, and the second 12 to 16 weeks later. They will have a PET/CT scan at each visit. A substance called a tracer will be injected into their arm. They will lie still on a table that moves through a doughnut-shaped machine. This process takes up to 2 hours. The other group will stop ART for no more than 90 days. This group will have 3 PET/CT scans over 8 months. Once they stop ART, they will visit the clinic weekly for blood tests. After restarting ART, they will continue to visit the clinic weekly until their HIV level is safe. All participants will have small samples of tissue taken from lymph nodes. They may also opt to provide semen samples or vaginal fluid. They may have samples taken of bone marrow or the fluid inside their spinal column.... |
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Detailed Description | Study Description: HIV persistence during antiretroviral therapy (ART) is the principal obstacle preventing cure from the infection, and new studies are essential to understand mechanisms and sources of persistence. Lymphoid tissue is a well-described compartment for HIV, but the mechanisms of HIV persistence during ART and rebound when ART is interrupted are not well understood. Metabolic activity in lymphoid tissue of participants on long-term ART is relatively low, and increases when ART is stopped. Such an increase in metabolic activity can be detected by 18fluorodeoxyglucose (FDG)-positron emission tomography (PET). It is not known whether this increase in metabolic activity represents sites of HIV replication or reflects immune activation in response to HIV replication. We will use FDG-PET imaging to identify areas of high and low metabolic uptake in lymphoid tissue of individuals undergoing long-term ART. Tissue samples will be collected by biopsy. Participants will then be randomized 1:1 to either continue ART or to interrupt ART in an analytic treatment interruption (ATI). Image-guided biopsy will be repeated 10 days after initiation of ATI. ATI will be continued until ART restart criteria are achieved, or a maximum of 90 days of ATI, and image-guided biopsy will be repeated for the ATI group after viral suppression is re-achieved. Participants who continue ART will have a second FDG-PET and collection of lymphoid biopsies 12 to 16 weeks after the first collection. During the study, participants will undergo assessments of genetic characteristics of HIV populations (diversity, phylogenetics, and clonal structure) in areas of high and low FDG uptake. In addition to investigating HIV in lymphoid tissue, optional assessments of non-lymphoid anatomic compartments, including cerebrospinal fluid (CSF) obtained by lumbar puncture (LP), may be performed to evaluate different reservoirs characteristics, which need to be addressed in cure strategies. Primary Objective: To evaluate if changes in glucose metabolism (as measured by FDG-PET standard uptake value, SUV) correlate with changes in levels of HIV RNA in lymphoid tissue before and after ATI. Secondary Objectives:
Tertiary/Exploratory Objectives:
Primary Endpoint: Proportion of participants who have a 3-fold increase in HIV RNA levels at tissue sites identified by imaging as having increased SUV on FDG-PET. Secondary Endpoints:
Tertiary/Exploratory Endpoints:
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Study Type ICMJE | Interventional | ||||
Study Phase ICMJE | Phase 2 | ||||
Study Design ICMJE | Allocation: Randomized Intervention Model: Parallel Assignment Masking: Single (Outcomes Assessor) Primary Purpose: Basic Science |
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Condition ICMJE | HIV | ||||
Intervention ICMJE | Other: Acute Treatment Interruption
Participants randomized to ATI will halt their ART medications starting 2 weeks (more or less 3 days) after the first imaging visit. This plan will be discussed with participants during the baseline visit. Patients will be contacted 1-3 days prior to ATI initiation. ATI may be delayed or cancelled if there are new safety concerns. HIV plasma viral levels and CD4 counts will be monitored every week during the ATI phase. If a participant meets any of the ART restart criteria during the ATI phase, then they will discontinue ATI and restart ART. Participants who do not meet restart criteria will remain off ART and continue to be monitored weekly until they have been on ATI for 90 days, and then will restart ART.
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Study Arms ICMJE |
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Publications * |
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* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline. |
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Recruitment Information | |||||
Recruitment Status ICMJE | Recruiting | ||||
Estimated Enrollment ICMJE |
50 | ||||
Original Estimated Enrollment ICMJE | Same as current | ||||
Estimated Study Completion Date ICMJE | August 1, 2026 | ||||
Estimated Primary Completion Date | August 1, 2026 (Final data collection date for primary outcome measure) | ||||
Eligibility Criteria ICMJE |
Participants must meet all of the following criteria to be eligible for this study:
EXCLUSION CRITERIA: Participants who meet any of the following criteria will be excluded from this study:
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Sex/Gender ICMJE |
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Ages ICMJE | 18 Years to 100 Years (Adult, Older Adult) | ||||
Accepts Healthy Volunteers ICMJE | No | ||||
Contacts ICMJE |
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Listed Location Countries ICMJE | United States | ||||
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Administrative Information | |||||
NCT Number ICMJE | NCT05419024 | ||||
Other Study ID Numbers ICMJE | 10000277 000277-C |
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Has Data Monitoring Committee | Not Provided | ||||
U.S. FDA-regulated Product |
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IPD Sharing Statement ICMJE |
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Current Responsible Party | National Institutes of Health Clinical Center (CC) ( National Cancer Institute (NCI) ) | ||||
Original Responsible Party | Same as current | ||||
Current Study Sponsor ICMJE | National Cancer Institute (NCI) | ||||
Original Study Sponsor ICMJE | Same as current | ||||
Collaborators ICMJE | Not Provided | ||||
Investigators ICMJE |
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PRS Account | National Institutes of Health Clinical Center (CC) | ||||
Verification Date | May 8, 2024 | ||||
ICMJE Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP |