CNS Viral Dynamics and Cellular Immunity During AIDS - Full Text View

Sponsor:	Vanderbilt University
Collaborator:	National Institutes of Health (NIH)
Information provided by:	Vanderbilt University
ClinicalTrials.gov Identifier:	NCT00583167

Purpose

Understanding whether or not viral replication occurs in the brain during chronic untreated HIV-1 infection is of undeniable importance, and has implications for treatment and research priorities. Evidence suggests that viral replication in the CNS occurs at the extremes of HIV-1 disease. Brain involvement has been reported during acute infection, and there is convincing evidence of CNS viral replication during HIV-associated dementia (HAD) and advanced AIDS. Some human and primate data suggest that viral RNA and proteins may be absent from brains of some individuals with chronic untreated HIV-1 infection despite abundant proviral DNA. However, the extent of viral replication in the brain is not known for most of the 42 million people worldwide living with untreated HIV-1 infection.

Why is viral replication in the brain such a pivotal issue? Microglial cells and macrophages are primary targets for intrathecal HIV-1 replication, and this can promote neuronal injury through direct effects of gp120 and tat, and indirect induction of toxic mediators. Low-grade injury over years or decades would likely be deleterious, particularly as the population ages. Because treatment guidelines allow systemic HIV-1 replication to continue until CD4+ T cell counts decline considerably, antiretroviral therapy (ART) is not recommended for many persons living with HIV. Demonstrating replication in the brain during chronic HIV-1 infection may affect treatment strategies and encourage investigation.

Identifying factors that modulate intrathecal viral replication is equally important. Anti-HIV-1 cytotoxic T lymphocytes (CTL) partially control systemic viral replication and delay disease progression. Although available data has been provocative, the role of anti-HIV CTL in the CNS has received little attention. To fill this gap we will examine relationships between intrathecal viral replication, CTL responses, and glial activation/proliferation during HIV-1 infection. These studies will be relevant not only to AIDS but to other inflammatory diseases of the CNS as well.

Condition
HIV Infections

Study Type:	Observational
Study Design:	Cohort, Prospective
Official Title:	CNS Viral Dynamics and Cellular Immunity During AIDS

Resource links provided by NLM:

MedlinePlus related topics: AIDS

U.S. FDA Resources

Further study details as provided by Vanderbilt University:

Primary Outcome Measures:

To characterize intrathecal viral replication during chronic untreated HIV-1 infection, and to assess how intrathecal viral replication relates to stage of HIV-1 disease. [ Time Frame: end of study ] [ Designated as safety issue: No ]
To measure intrathecal and systemic cellular immune responses against HIV-1 and to assess how these responses relate to intrathecal viral replication. [ Time Frame: end of study ] [ Designated as safety issue: No ]
To correlate intrathecal viral replication and anti-HIV CTL responses with the degree of glial activation/proliferation and neuronal dropout in the brain. [ Time Frame: end of study ] [ Designated as safety issue: No ]

Biospecimen Retention: Samples With DNA

Biospecimen Description:

whole blood, plasma, CSF

Estimated Enrollment:	50
Study Start Date:	March 2006
Estimated Study Completion Date:	December 2010
Estimated Primary Completion Date:	March 2010 (Final data collection date for primary outcome measure)

Groups/Cohorts
A1 HIV-infected subjects who are at least 18 years of age, with no ART in the previous 3 months, and with plasma HIV-1 RNA >20,000 copies/mL. CD4+ T cell count >200 cells/mm3. Group A1 will undergo continuous CSF sampling via intrathecal catheter.
A2 HIV-infected subjects who are at least 18 years of age, with no ART in the previous 3 months, and with plasma HIV-1 RNA >20,000 copies/mL. CD4+ T cell count <200 cells/mm3. Group A2 will undergo continuous CSF sampling via intrathecal catheter.
B HIV-infected subjects who are at least 18 years of age, with no ART in the previous 3 months, and with plasma HIV-1 RNA >20,000 copies/mL. Group B will not undergo continuous CSF sampling, but will undergo sparse CSF sampling by lumbar punctures.

Eligibility

Ages Eligible for Study:	18 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No
Sampling Method:	Non-Probability Sample

Study Population

HIV-infected subjects who are at least 18 years of age, with no ART in the previous 3 months, and with plasma HIV-1 RNA >20,000 copies/mL. Individuals with past ART experience must have the ability to construct an ART regimen predicted to completely suppress plasma HIV-1 RNA, based on results of viral susceptibility testing that is done as a routine part of clinical practice.

Criteria

Inclusion Criteria:

(All subjects in Groups A1, A2 and B):
At least 18 years of age.
No more than one month of ART in the past.
No ART in the previous 3 months.
Platelet count >100,000 cells/mm3 on most recent determination within 60 days prior to first study lumbar puncture.
Normal prothrombin time (PT) and partial thromboplastin time (PTT) on most recent determination within 60 days prior to first study lumbar puncture.
Among individuals with past ART experience, the ability to construct an ART regimen predicted to completely suppress plasma HIV-1 RNA, based on results of viral susceptibility testing that is done as a routine part of clinical practice.
Plasma HIV-1 RNA >20,000 copies/mL.
Additional Inclusion Criteria for Groups A1 and A2.
Group A1:
CD4+ T cell count >200 cells/mm3.
CSF HIV-1 RNA >2,000 copies/mL on screening lumbar puncture.
No history of significant allergy to beta lactam antibiotics, including penicillins and cephalosporins.
No history of allergy to vancomycin.
Group A2:
CD4+ T cell count <200 cells/mm3.
CSF HIV-1 RNA >2,000 copies/mL on screening lumbar puncture.
No history of significant allergy to beta lactam antibiotics, including penicillins and cephalosporins.
No history of allergy to vancomycin.

Exclusion Criteria:

Evidence of CNS opportunistic infections or space occupying lesion.
History of significant CNS disorder unrelated to HIV infection such as trauma, congenital malformations or genetic disorders.
History of seizures.
As determined by the investigator, a significant active or previous history of cardiovascular, renal, liver, hematologic, neurologic, gastrointestinal, psychiatric, or endocrine disease(s) that would interfere with study participation.
Evidence or suspicion of vascular or Alzheimer's type dementias.
Evidence or suspicion of Parkinson's disease.
History of allergy to lidocaine.
Implanted metal objects that make MRI contraindicated. This may require consultation with colleagues in the Vanderbilt Dept. of Radiology.
Women who are pregnant or breastfeeding.
Women with a positive pregnancy test on enrollment or prior to study drug administration.
Women of childbearing potential (WOCBP) who are unwilling or unable to use an adequate method of contraception to avoid pregnancy throughout the study in such a manner that the risk of pregnancy is minimized.
Prisoners or subjects who are compulsorily detained (involuntarily incarcerated) for treatment of either a psychiatric or physical (e.g., infectious disease) illness must not be enrolled into this study.

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00583167

Contacts

Contact: Deborah Sutherland, RN, BSN	615-467-0154 ext 109	deborah.sutherland@vanderbilt.edu
Contact: Becky Basham	615-467-0154 ext 117	rebecca.j.basham@vanderbilt.edu

Locations

United States, Tennessee
Vanderbilt AIDS Clinical Trials Center	Recruiting
Nashville, Tennessee, United States, 37203

Sponsors and Collaborators

Vanderbilt University

National Institutes of Health (NIH)

Investigators

Principal Investigator:

David W. Haas, MD

Vanderbilt University

More Information

No publications provided

Responsible Party:	Vanderbilt University ( David W. Haas, MD )
Study ID Numbers:	050001, R01 MH071205
Study First Received:	December 26, 2007
Last Updated:	April 29, 2009
ClinicalTrials.gov Identifier:	NCT00583167 History of Changes
Health Authority:	United States: Institutional Review Board; United States: Federal Government

Keywords provided by Vanderbilt University:

HIV
AIDS
CNS
brain
affects

Additional relevant MeSH terms:

Virus Diseases
Sexually Transmitted Diseases, Viral
RNA Virus Infections
Slow Virus Diseases
Immune System Diseases
HIV Infections

Sexually Transmitted Diseases
Acquired Immunodeficiency Syndrome
Lentivirus Infections
Infection
Retroviridae Infections
Immunologic Deficiency Syndromes

ClinicalTrials.gov processed this record on February 08, 2010