2000HIV Trained Innate Immunity in HIV Elite Controllers

NCT ID: NCT04968717

Last Updated: 2023-11-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

109 participants

Study Classification

OBSERVATIONAL

Study Start Date

2021-08-02

Study Completion Date

2021-10-27

Brief Summary

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Some individuals are able to spontaneously control HIV replication, the so-called 'elite controllers' (ECs). ECs are crucial for our understanding of HIV infection. While there is more and more evidence pointing towards a role of the innate immune system in elite control, no research has been performed on the role of innate trained immunity in elite control of HIV.

In this cross-sectional case-control study, we will study this role of trained immunity in HIV elite control by comparing ECs both to a non-HIV-infected first-degree relative, and to HIV patients who are not elite controllers. In addition, we will study whether HIV itself can induce a trained innate immunity phenotype.

Detailed Description

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Rationale:

It remains unknown how some individuals spontaneously control HIV in the absence of antiretroviral medication, called HIV 'elite controllers' (ECs). ECs have been absolutely crucial to our current understanding of control of HIV replication. While research has mainly focused on the adaptive immune system, there is a vast amount of evidence indicating that the innate immune system is essential to HIV elite control.

Trained innate immunity can be expressed in terms of enhanced responsiveness of innate immune cells to a repeated trigger. This occurs through epigenetic remodeling after exposure to certain stimuli, such as beta-glucan, lipopolysaccharide (LPS) or the bacillus Calmette-Guérin (BCG) vaccine. Innate training results in an altered gene expression and metabolic reqiring on a cellular level, resulting in greater resistance against subsequent infection.

Both the impact of trained immunity on HIV infections and vice versa, the impact of HIV on trained immunity, are unknown. Our hypothesis is that ECs are natural hyper-responders to innate immune training triggers and that this aids in the HIV elite control phenotype.

Objectives:

1. (Primary) Investigate if a trained immunity profile in innate immune cells plays a role in HIV elite control.
2. (Secondary) Determine the immune phenotypes that distinguish family members of HIV elite controllers from family members of people living with HIV who have never been controllers.
3. (Secondary) Determine whether HIV can induce a long-term functional and transcriptional program in innate immune cells similar to trained immunity.

Study design:

Cross-sectional case-control study.

For the primary objective, HIV elite controllers will be compared to ART-suppressed HIV patients who never have been elite controllers and first-degree relatives of HIV elite controllers will be compared to first-degree relatives of ART-suppressed HIV patients who have never been elite controllers.

For the secondary objectives, first, a system biology approach will be used in the comparison above. To determine the role of HIV in trained innate immunity we will compare people living with HIV (both controllers as non-controllers) to their respective family members.

Conditions

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HIV-1-infection

Study Design

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Observational Model Type

CASE_CONTROL

Study Time Perspective

CROSS_SECTIONAL

Study Groups

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HIV elite controllers

Non-viremic elite controller:

HIV-positive , \> 1 year without cART AND with \>3 consecutive HIV-RNA \< 75 copies/ml spanning \>12 months AND stable CD4\> 500 cells/uL.(i.e. \>75% of measurements)

OR on cART, but before start cART \> 1 year without cART AND with \>3 consecutive HIV-RNA \< 75 copies/ml spanning \>12 months AND stable CD4\> 500 cells/uL. (i.e. \>75% of measurements)

Viremic elite controller:

HIV-positive \>5 year without cART AND with always HIV-RNA \>50-10.000 copies/ml AND always CD4\> 500 cells/uL.

OR on cART, but before start cART \>5 year without cART AND with always HIV-RNA \>50-10.000 copies/ml AND always CD4\> 500 cells/uL

No interventions assigned to this group

First-degree relatives of HIV elite controllers

No interventions assigned to this group

cART-treated non-controller HIV patients

No interventions assigned to this group

First-degree relatives of cART-treated non-controller HIV patients

No interventions assigned to this group

Eligibility Criteria

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Inclusion Criteria

First-degree relatives:

Aside from the criteria for all participants mentioned above, there are no additional criteria for first-degree relatives of participants with HIV. If multiple first-degree relatives are available, siblings are preferred. If no sibling is available, then children \>18 years. If no children \>18 years, then parents. If there is still multiple options, same-sex will be preferred over different-sex relatives.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Erasmus Medical Center

OTHER

Sponsor Role collaborator

Onze Lieve Vrouwe Gasthuis

OTHER

Sponsor Role collaborator

Elisabeth-TweeSteden Ziekenhuis

OTHER

Sponsor Role collaborator

Radboud University Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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OLVG

Amsterdam, , Netherlands

Site Status

Radboudumc

Nijmegen, , Netherlands

Site Status

Erasmus MC

Rotterdam, , Netherlands

Site Status

Countries

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Netherlands

Other Identifiers

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2021-7495

Identifier Type: OTHER

Identifier Source: secondary_id

NL76999.091.21

Identifier Type: -

Identifier Source: org_study_id