A Pilot Study of the Effect of Minocycline on Cerebrospinal Fluid HIV-1 Infection

This study has been completed.
Sponsor:
Information provided by:
University of California, San Francisco
ClinicalTrials.gov Identifier:
NCT01064752
First received: February 5, 2010
Last updated: NA
Last verified: April 2009
History: No changes posted
  Purpose

This will be an uncontrolled, open-labelled pilot study exploring whether minocycline has a measurable and selective effect on HIV infection of the central nervous system.


Condition Intervention
HIV Infection
Drug: Minocycline

Study Type: Observational
Study Design: Observational Model: Case-Only
Time Perspective: Prospective
Official Title: A Pilot Study of the Effect of Minocycline on Cerebrospinal Fluid HIV-1 Infection

Resource links provided by NLM:


Further study details as provided by University of California, San Francisco:

Biospecimen Retention:   Samples With DNA

Samples of both cerebrospinal fluid and blood will also be frozen and stored.


Enrollment: 7
Study Start Date: April 2005
Study Completion Date: October 2009
Primary Completion Date: October 2009 (Final data collection date for primary outcome measure)
Groups/Cohorts Assigned Interventions
Minocycline
HIV-1 infected, not on anti-retroviral medication
Drug: Minocycline
100 mg po bid for 8 weeks

Detailed Description:

This study is founded on a sequence of related hypotheses: 1. inflammatory responses related to activation of macrophages importantly contribute to the magnitude of CNS HIV infection by increasing the local production of viral progeny; 2. the tetracycline, minocycline, has anti-inflammatory properties which likely underlie studies showing that this drug can inhibit HIV-1 infection in macrophages and microglia in vitro and reduce simian immunodeficiency virus (SIV) encephalitis in macaques; 3. by reducing CNS monocyte/macrophage/microglial activation, minocycline will therefore reduce CNS HIV infection; 4. CSF will reflect or parallel (and thus serve as a 'model' of) brain infection and inflammation in this setting; 5. therefore, longitudinal CSF monitoring can assess the effect of minocycline on both CNS HIV infection and inflammation; 6. because the brain injury underlying AIDS dementia complex (ADC) and its pathological substrate, HIV encephalitis, critically involve inflammatory processes and, in the broad sense, immunopathology, minocycline might eventually prove useful as an adjunct to antiviral therapy in accelerating recovery from this condition (though importantly, this pilot study will not include ADC patients).

This will be an uncontrolled, open-labelled pilot study exploring whether minocycline has a measurable and selective effect on CSF HIV RNA concentration. There are no previous studies examining this effect in humans. We define a priori a 'biologically meaningful' effect to be an increase in the Δplasma-CSF HIV concentration of >0.5 log10 copies/mL of HIV RNA (i.e. an increase in the difference between plasma and CSF of >0.5 log10 copies/mL of HIV RNA compared to the baseline difference) in the face of unchanged or reduced plasma HIV RNA. Reductions in the absolute levels of CSF and plasma HIV as well as reductions in CSF inflammatory markers and T cell activation will also be of interest.

This study will serve as an initial exploration of the possible therapeutic effect of minocycline on CNS HIV infection. Our overall strategy is to begin with this pilot study, and if the results look promising (biological effect and lack of toxicity), to use these results to design a controlled trial, either as a single or multi-institutional study.

Additionally, this study shares an almost identical design with another proposed study examining the effects of atorvastatin on CSF HIV infection. While neither of these studies is controlled, they will yield pilot comparative results.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   Yes
Sampling Method:   Non-Probability Sample
Study Population

HIV-infected subjects >18 years old not on antiretroviral therapy who are willing to volunteer to take minocycline and undergo the four study LPs and other evaluations recruited from the San Francisco Bay area.

Criteria

Inclusion Criteria:

  1. HIV infection with plasma and CSF HIV RNA concentrations (using Roche Amplicor assay) > 1,000 copies/ mL (available after baseline LP).
  2. Off antiretroviral therapy (ART) for > 6 weeks before the study and no plans to begin treatment for the study duration. (The decision of whether or not a subject takes antiretroviral therapy will be made by the subject in consultation with his/her primary care provider prior to screening for this study.)
  3. Predicted adherence to the medication.
  4. Capable of providing informed consent.
  5. > 18 years old
  6. CD4 cell counts >150 cells/μL (though likely most, if not all, will be >250 cells/μL).
  7. When available, subjects will be screened for stability of blood CD4 and HIV RNA levels.

Exclusion Criteria:

  1. Taking a tetracycline within 6 months or history of adverse reaction to minocycline or another tetracycline.
  2. Enhanced risk from lumbar puncture, including documented or suspected cerebral mass lesion predisposing to brain herniation or bleeding diathesis.
  3. Pregnancy or expectation of pregnancy during the study.
  4. Active opportunistic infection or active neurological disease that might confound evaluation.
  5. ADC Stage > 1.
  6. Hemoglobin < 10 Gms/dL.
  7. BUN or creatine above the normal limits.
  8. Taking other drugs known to reduce the metabolism of minocycline and thus increase the probability of toxicity.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01064752

Sponsors and Collaborators
University of California, San Francisco
Investigators
Principal Investigator: Richard W Price, MD University of California, San Francisco
  More Information

No publications provided

Responsible Party: Richard W. Price, MD, University of California San Francisco
ClinicalTrials.gov Identifier: NCT01064752     History of Changes
Other Study ID Numbers: H9133-26156-04
Study First Received: February 5, 2010
Last Updated: February 5, 2010
Health Authority: United States: Institutional Review Board

Keywords provided by University of California, San Francisco:
Minocycline
HIV-1
Immune activation
Cerebrospinal fluid
Observational

Additional relevant MeSH terms:
HIV Infections
Acquired Immunodeficiency Syndrome
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Immunologic Deficiency Syndromes
Immune System Diseases
Slow Virus Diseases
Minocycline
Anti-Bacterial Agents
Anti-Infective Agents
Therapeutic Uses
Pharmacologic Actions

ClinicalTrials.gov processed this record on July 29, 2014