Safety and Efficacy of Sirolimus for HIV Reservoir Reduction in Individuals on Suppressive Antiretroviral Therapy (ART)

NCT ID: NCT02440789

Last Updated: 2021-08-03

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE1/PHASE2
• Total Enrollment: 32 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2015-12-21
• Study Completion Date: 2018-02-01

Brief Summary

The purpose of this study was to find out about the safety of sirolimus in individuals with HIV infection who were also being treated with ART. The investigators wanted to learn whether sirolimus decreases inflammation and immune activation in the body; whether sirolimus changes the level of HIV in the participants' blood; and how sirolimus interacts with ART in the blood. Sirolimus is approved by the Food and Drug Administration (FDA) to prevent organ rejection in patients aged 13 years and older receiving kidney transplants. Sirolimus had also been used for the prevention of complications after stem cell transplants and as a treatment for certain kinds of cancers in HIV-infected patients.

Detailed Description

The study was conducted with an initial lead-in period of 12 weeks where participants remained on ART, without study intervention. Samples were collected to define the pre-intervention steady-state of HIV, inflammation and immune activation parameters.

At week 12, sirolimus therapy was initiated for the planned 20 weeks of treatment. In order to achieve therapeutic levels, sirolimus therapy was initiated with lead-in dose of 0.025 or 0.05 mg/kg/day, depending on the ART regimen. Doses for each participant were then adjusted, based on trough blood sirolimus concentrations, to achieve target concentrations between 5 and 10 ng/mL. There were frequent initial visits for sirolimus trough concentration monitoring and potential dose adjustments, at weeks 12.5, 13, 13.5, 14, 14.5, 15, 15.5 and 16. Then visits occurred at weeks 18, 20, 24, 28 and 32. After the week 32 visit, the planned end of study treatment, there was an additional 12 weeks of post-sirolimus follow-up, with a final visit at week 44.

Study visits included physical examinations, clinical assessments, safety monitoring, and blood and oral swab collection. Anal swabs were collected at week 12 and 32. Samples were stored for subsequent protocol testing for the study outcomes.

In the primary analysis, the significance level was 0.05 for all analyses.

Conditions

HIV-1 Infection

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Sirolimus

Group Type: EXPERIMENTAL

Sirolimus

Intervention Type: DRUG

Participants on a non-protease inhibitor (PI), non-non-nucleoside reverse transcriptase inhibitor (NNRTI) regimen, and for those on a non-PI, rilpivirine (RPV) based regimen received 0.025 mg/kg/day initial dose for 20 weeks.

Participants on an NNRTI regimen with the exception of RPV received 0.05 mg/kg/day initial dose for 20 weeks.

Interventions

Sirolimus

Participants on a non-protease inhibitor (PI), non-non-nucleoside reverse transcriptase inhibitor (NNRTI) regimen, and for those on a non-PI, rilpivirine (RPV) based regimen received 0.025 mg/kg/day initial dose for 20 weeks.

Participants on an NNRTI regimen with the exception of RPV received 0.05 mg/kg/day initial dose for 20 weeks.

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

• HIV-1 infection
• On continuous ART for ≥24 months prior to study entry.
• CD4+ cell count ≥350 cells/mm^3
• Plasma HIV-1 RNA below the level of quantification for ≥24 months.
• White blood cell (WBC) ≥3000/mm^3
• Platelet count ≥125,000/mm^3
• Absolute neutrophil count (ANC) >1300/mm^3
• Aspartate aminotransferase (AST) <1.25 x upper limit of normal (ULN)
• Alanine aminotransferase (ALT) <1.25 x ULN
• Calculated creatinine clearance (CrCl) ≥60 mL/min
• Fasting or non-fasting triglyceride level ≤350 mg/dL
• Fasting or non-fasting LDL <160 mg/dL
• Urine protein to urine creatinine ratio ≤1 g/g from random urine collection

Exclusion Criteria

• Serious illness requiring systemic treatment and/or hospitalization
• Documentation of any CDC Category C AIDS-indicator condition or oropharyngeal candidiasis (thrush)
• Intended modification of ART during the study.
• Latent tuberculosis (TB) infection
• TB disease within 48 weeks prior to study entry requiring treatment.
• History of active hepatitis B (HBV) infection.
• Hepatitis C virus (HCV) RNA-positive
• Previous myelodysplasia syndrome, lymphoproliferative disease, lung disease, malignancies, congestive heart failure, life-threatening fungal infection or herpes-zoster/varicella-zoster viral infection requiring treatment.
• Detectable Epstein-Barr virus (EBV) in blood
• Active infection other than HIV that required receipt of systemic antibiotic therapy by intravenous infusion
• History of major hypersensitivity reaction to macrolide drugs including angioedema, anaphylaxis, drug-induced dermatitis, or hypersensitivity vasculitis.
• Currently pregnant or breastfeeding, or planning to become pregnant prior to or during the study.
• Use of immunomodulators (eg, interleukins, interferons, and cyclosporine), HIV vaccine, systemic cytotoxic chemotherapy, or investigational therapy.
• Active drug or alcohol use or dependence
• Vaccination within 14 days prior to study entry.
• On or planned to change to a PI-based ART or cobicistat-boosted regimen
• Anti-human papillomavirus (HPV) therapies

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

National Institute of Allergy and Infectious Diseases (NIAID)

NIH

Sponsor Role: collaborator

Advancing Clinical Therapeutics Globally for HIV/AIDS and Other Infections

NETWORK

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Timothy Henrich, MD

Role: STUDY_CHAIR

University of California, San Francisco

Priscilla Hsue, MD

Role: STUDY_CHAIR

University of California, San Francisco

Locations

801 University of California, San Francisco HIV/AIDS CRS

San Francisco, California, United States

Whitman Walker Health CRS (31791)

Washington D.C., District of Columbia, United States

Univ. of Miami AIDS CRS (901)

Miami, Florida, United States

The Ponce de Leon Center CRS (5802)

Atlanta, Georgia, United States

Washington University CRS (2101)

St Louis, Missouri, United States

Weill Cornell Uptown CRS (7803)

New York, New York, United States

31787 University of Rochester Adult HIV Therapeutic Strategies Network CRS

Rochester, New York, United States

Univ. of Cincinnati CRS (2401)

Cincinnati, Ohio, United States

Houston AIDS Research Team CRS (31473)

Houston, Texas, United States

University of Washington AIDS CRS (1401)

Seattle, Washington, United States

Countries

United States

Provided Documents

Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Related Links

http://rsc.niaid.nih.gov/

DAIDS Table for Grading the Severity of Adult and Pediatric Adverse Events (DAIDS AE Grading Table), Version 2.0, November 2014

https://rsc.niaid.nih.gov/

Manual for Expedited Reporting of Adverse Events to DAIDS (DAIDS EAE Manual) Version 2.0 January 2010

Other Identifiers

2UM1AI068636

Identifier Type: NIH

Identifier Source: secondary_id

View Link

ACTG A5337

Identifier Type: -

Identifier Source: org_study_id