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Valproic Acid and Its Effects on HIV Latent Reservoirs

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT00289952
Recruitment Status : Completed
First Posted : February 10, 2006
Last Update Posted : March 15, 2023
Sponsor:
Collaborators:
Canadian Foundation for AIDS Research (CANFAR)
CIHR Canadian HIV Trials Network
Information provided by (Responsible Party):
Jean-Pierre Routy, McGill University Health Centre/Research Institute of the McGill University Health Centre

Study Description
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Brief Summary:
The purpose of this study is to examine whether the co-administration of valproic acid (Epival®), with highly active antiretroviral therapy (HAART) can reduce the size of HIV latent reservoirs in infected CD4 cells.

Condition or disease Intervention/treatment Phase
HIV Infections Drug: Valproic Acid Drug: HAART Phase 2

Detailed Description:
Participants must be on HAART with a suppressed viral load (< 50 copies/ml) for at least the previous 12 months. They will be randomly assigned to one of two groups, one group will start the valproic acid right away at week 1 for 16 weeks, and the other group will wait until week 17 to add valproic acid to their treatment for 32 weeks. Subjects will be followed every four weeks for one year and evaluated by a variety of assays, all carried out using well-established methods, to assess the main outcome defined by changes in HIV reservoir size measured by the mean frequency of resting CD4 memory cells carrying HIV proviral DNA.
Study Design
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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 50 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Use of Valproic Acid to Purge HIV From Resting CD4+ Memory Cells/ A Proof-of-concept Study
Study Start Date : June 2006
Actual Primary Completion Date : December 2012
Actual Study Completion Date : December 2012

Resource links provided by the National Library of Medicine

MedlinePlus related topics: HIV/AIDS Memory

Arms and Interventions
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Arm Intervention/treatment
Experimental: Group 1
HAART + valproic acid for 16 weeks followed by HAART alone for 32 weeks.
 Drug: Valproic Acid
Oral valproic acid twice daily for 16 or 32 weeks. Dosage varies based on plasma levels.

Drug: HAART
As per standard of care.
Experimental: Group 2
HAART alone for 16 weeks followed by HAART + valproic acid for 32 weeks.
 Drug: Valproic Acid
Oral valproic acid twice daily for 16 or 32 weeks. Dosage varies based on plasma levels.

Drug: HAART
As per standard of care.


Outcome Measures
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Primary Outcome Measures :
  1. To assess the effect of VPA on HIV reservoirs measured by the frequency of resting CD4+ memory cells carrying HIV proviral DNA in peripheral blood of chronically HIV-infected subjects. [ Time Frame: 16 or 32 weeks ]

Secondary Outcome Measures :
  1. To assess the clinical and biological tolerance of VPA in chronically HIV-infected patients with undetectable viral load. [ Time Frame: 16 or 32 weeks ]
  2. To explore the changes in CD4/CD8 ratio, as the size of reservoir is thought to be inversely correlated with the frequency of resting CD4+ memory cells carrying HIV proviral DNA. [ Time Frame: 48 weeks ]
  3. To explore the frequency of CD4+ memory cell subsets (Tcm, Tpm and Tem) carrying HIV proviral DNA. [ Time Frame: 48 weeks ]
  4. To explore level of T-cell activation after VPA intervention. [ Time Frame: 48 weeks ]
  5. To assess levels of certain cytokines and chemokines, which are involved in T-cell proliferation and differentiation. [ Time Frame: 48 weeks ]

Eligibility Criteria
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Ages Eligible for Study:   18 Years to 80 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

Documented HIV seropositive infection by Western Blot, EIA assays or viral load.

  • Aged 18 years old or older.
  • Viral load <50 copies/ml for at least the previous 12 months.
  • Circulating CD4+ cell count ³ 200 cells/ml.
  • Taking HAART.
  • Vital signs, physical examination and laboratory results do not exhibit evidence of diseases such as advanced cirrhosis and advanced liver disease (ALT or AST > 5 x upper limit of normal value).
  • Karnofsky performance status 80%.
  • Subject does not require and agrees not to take, for the duration of the study, any medication that is contraindicated with VPA.
  • Willing and able to give informed consent.
  • All participants will agree to abstinence or to used effective methods of contraception while on the study.

Exclusion Criteria:

  • Pregnant or breast-feeding women.
  • Psychiatric or cognitive disturbance or illness that could preclude compliance with the study.
  • Current use or use within four weeks prior to the baseline visit, of cytotoxic agents, systemic corticosteroids or any immunomodulatory agents such as intravenous immunoglobulin, or hydroxyurea.
  • HIV vaccine within six months of screening visit
  • Allergic reaction to VPA.
  • Active intravenous drug users.
  • History of bleeding disorders.
  • Unstable or treated hypertension.
  • Past-history of pancreatitis or chronic liver disease (ALT or AST > 5 x upper limit of normal value). However subject co-infected with hepatitis B or C can participate if ALT or AST is < 5 x upper limit of normal value.
  • Renal failure (creatinine > 2 x upper limit of normal value).
  • Ammonemia (> 2x upper limit of normal value).
  • Taking Zidovudine (AZT), or combination of drugs containing AZT like Combivir or Trizivir. However this subject will be asked to switch to another NRTI,at least two weeks prior to Valproic Acid initiation, to become eligible.
  • Taking on daily basis: phenytoin, carbamazepine, phenobarbital, warfarin or aspirin.
  • Subject has any of the following abnormal laboratory results Hemoglobin < 100 g/L. Absolute neutrophil count < 0.75 x 10 9 cells/L. Platelet count < 50 x 10 9 cells/L.
  • Subject suffering from urea cycle disorders.
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00289952


Locations
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Canada, British Columbia
BC St-Paul's Hospital/Immunodeficiency Clinic
Vancouver, British Columbia, Canada, V6Z 1Y6
Canada, Ontario
Ottawa Health Research Institute/Immunodeficiency Clinic
Ottawa, Ontario, Canada, K1H 8L6
Canada, Quebec
Actuel Medical Clinic
Montreal, Quebec, Canada, H2L 4P9
Quartier Latin Medical Clinic
Montreal, Quebec, Canada, H2L 5B1
Montreal Chest Institute/Immunodeficiency Clinic
Montreal, Quebec, Canada, H2X 2P4
CHUL Ste-Foy
Ste-Foy, Quebec, Canada, G1V 4G2
Sponsors and Collaborators
Jean-Pierre Routy
Canadian Foundation for AIDS Research (CANFAR)
CIHR Canadian HIV Trials Network
Investigators
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Principal Investigator: Jean-Pierre Routy, MD Royal-Victoria Hospital/McGill University Health Centre
More Information
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Additional Information:

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

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Responsible Party: Jean-Pierre Routy, Dr Jean-Pierre Routy, McGill University Health Centre/Research Institute of the McGill University Health Centre
ClinicalTrials.gov Identifier: NCT00289952    
Other Study ID Numbers: BMB#05-018 (CTN-205)
First Posted: February 10, 2006    Key Record Dates
Last Update Posted: March 15, 2023
Last Verified: March 2023
Keywords provided by Jean-Pierre Routy, McGill University Health Centre/Research Institute of the McGill University Health Centre:
HIV infections
Histone deacetylase Inhibitor
HIV Reservoirs
 Peripheral Blood Mononuclear Cells
Valproic Acid
Treatment Experienced
Additional relevant MeSH terms:
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HIV Infections
Infections
Blood-Borne Infections
Communicable Diseases
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Genital Diseases
Urogenital Diseases
Immunologic Deficiency Syndromes
 Immune System Diseases
Valproic Acid
Anticonvulsants
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
GABA Agents
Neurotransmitter Agents
Physiological Effects of Drugs
Antimanic Agents
Tranquilizing Agents
Central Nervous System Depressants
Psychotropic Drugs