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Trial record 1 of 1 for:    A5324
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Integrase and Maraviroc Intensification in Neurocognitive Dysfunction (InMIND)

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: NCT02519777
Recruitment Status : Completed
First Posted : August 11, 2015
Results First Posted : March 2, 2022
Last Update Posted : April 22, 2022
Sponsor:
Information provided by (Responsible Party):
National Institute of Allergy and Infectious Diseases (NIAID)

Brief Summary:
People infected with HIV often have cognitive dysfunction even if they are on antiretroviral therapy (ART) and have undetectable viral loads. The study evaluated if the addition of maraviroc (MVC) and dolutegravir (DTG) (which are two antiretroviral [ARV] medications) to participants' existing ART regimens improved participants' neurocognitive performance.

Condition or disease Intervention/treatment Phase
HIV Infections Drug: Placebo for maraviroc (MVC) Drug: Placebo for dolutegravir (DTG) Drug: Dolutegravir (DTG) Drug: Maraviroc (MVC) Phase 4

Detailed Description:

HIV-infected people often have cognitive dysfunction (HIV-associated neurocognitive disorder, or HAND), which includes asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND), and HIV-associated dementia (HAD), even if they are on ART and have undetectable viral loads. In this study, researchers evaluated the effectiveness of adding MVC and DTG to the current ART regimen of HIV-infected people with undetectable (<50 copies/mL) plasma HIV-1 RNA who had neurocognitive impairment and who had been on stable ART for at least 6 months prior to study entry. The purpose of this study was to evaluate if the addition of MVC and DTG to participants' existing ART regimens improved participants' neurocognitive performance.

Participants were randomly assigned to one of three arms. All participants remained on their existing ART regimens; they took their assigned study drugs in addition to their ART regimen. Study visits occurred at entry and Weeks 2, 4, 12, 24, 48, 72, and 96. Visits may have included physical examinations, blood collection, neurocognitive testing, pregnancy testing, and questionnaires. Some participants may have had an optional lumbar puncture procedure at study entry and Week 48. Participants returned for refills of study drugs on Weeks 36, 60, and 84.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 191 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Randomized, Double-Blinded, Placebo-Controlled Trial Comparing Antiretroviral Intensification With Maraviroc and Dolutegravir With No Intensification or Intensification With Dolutegravir Alone for the Treatment of Cognitive Impairment in HIV
Actual Study Start Date : April 21, 2016
Actual Primary Completion Date : December 2, 2019
Actual Study Completion Date : January 5, 2021

Resource links provided by the National Library of Medicine

MedlinePlus related topics: HIV/AIDS

Arm Intervention/treatment
Placebo Comparator: Arm A: Placebo MVC and placebo DTG
In addition to their existing ART regimens, participants in Arm A received placebo for MVC and placebo for DTG.
Drug: Placebo for maraviroc (MVC)
Administered orally as one 150 mg tablet BID OR two 300 mg tablet BID OR one 300 mg tablet BID depending upon background ARV regimen

Drug: Placebo for dolutegravir (DTG)
Administered orally as one 50 mg tablet BID OR one 50 mg tablet QD depending upon background ARV regimen

Experimental: Arm B: DTG and placebo MVC
In addition to their existing ART regimens, participants in Arm B received DTG and placebo for MVC.
Drug: Placebo for maraviroc (MVC)
Administered orally as one 150 mg tablet BID OR two 300 mg tablet BID OR one 300 mg tablet BID depending upon background ARV regimen

Drug: Dolutegravir (DTG)
Administered orally as one 50 mg tablet BID OR one 50 mg tablet QD depending upon background ARV regimen

Experimental: Arm C: MVC and DTG
In addition to their existing ART regimens, participants in Arm C received MVC and DTG
Drug: Dolutegravir (DTG)
Administered orally as one 50 mg tablet BID OR one 50 mg tablet QD depending upon background ARV regimen

Drug: Maraviroc (MVC)
Administered orally as one 150 mg tablet BID OR two 300 mg tablet BID OR one 300 mg tablet BID depending upon background ARV regimen




Primary Outcome Measures :
  1. Change in Normalized Composite Neurocognitive Test Score at Week 48 From Baseline [ Time Frame: Measured at Baseline and Week 48 ]

    The normalized composite neurocognitive test score (total z-score) was defined as the average of the z-scores from the following tests:

    Domestic (US-based) and International Participants:

    • Grooved pegboard dominant
    • Grooved pegboard non-dominant
    • Hopkins Verbal Learning Test (HVLT-R) Learning trials
    • HVLT-R Delayed recall
    • HVLT-R Delayed recognition
    • Semantic verbal fluency

    Domestic only:

    • Stroop color naming
    • Stroop word reading
    • Stroop interference trial
    • Letter fluency
    • Trail Making A
    • Trail Making B
    • WAIS-III Symbol search
    • Digit Symbol

    International only:

    • Timed Gait
    • Finger Tapping Dominant
    • Finger Tapping Non-dominant
    • Color Trail 1

    Z-scores were calculated using a demographically appropriate norming process. Higher z-scores correspond with better neurocognitive performance. Change was calculated as the total z-score at Week 48 minus the total z-score at Baseline.



Secondary Outcome Measures :
  1. Number of Participants With Treatment Related Adverse Events (AEs) [ Time Frame: Measured from treatment initiation through Week 96 ]
    Treatment Related Adverse Events were determined by the study sites indicating a relationship between an adverse event and the study treatment.

  2. Change in Normalized Composite Neurocognitive Test Score at Weeks 24, 72, and 96 From Baseline [ Time Frame: Measured at Baseline and Weeks 24, 72, and 96 ]

    The normalized composite neurocognitive test score (total z-score) was defined as the average of the z-scores from the following tests:

    Domestic and International Participants:

    • Grooved pegboard dominant
    • Grooved pegboard non-dominant
    • HVLT-R Learning trials
    • HVLT-R Delayed recall
    • HVLT-R Delayed recognition
    • Semantic verbal fluency

    Domestic only:

    • Stroop color naming
    • Stroop word reading
    • Stroop interference trial
    • Letter fluency
    • Trail Making A
    • Trail Making B
    • WAIS-III Symbol search
    • Digit Symbol

    International only:

    • Timed Gait
    • Finger Tapping Dominant
    • Finger Tapping Non-dominant
    • Color Trail 1
    • Color Trail 2

    Z-scores were calculated using a demographically appropriate norming process. Higher z-scores correspond with better neurocognitive performance. Change was calculated as the total z-score at the given time point minus the total z-score at Baseline.


  3. Change in Functional Status Scores [ Time Frame: Measured at Baseline and Weeks 24, 48, 72, and 96 ]
    Functional status scores were calculated based on the instrumental activities of daily living (IADLs) forms. IADL scores were calculated as the sum of the eight IADL tasks where the task scores were equal to 1 if a participant did not need assistance with the task and equal to 0 if a participant needed some level of help with the task. The maximum possible functional status score was 8, while the minimum possible functional status score was 0, with higher functional status scores indicating a higher level of functionality.

  4. Number of Participants With Plasma HIV-1 RNA Greater Than or Equal to 50 Copies/mL [ Time Frame: Measured at Weeks 24, 48, and 96 ]
    The number of participants with Plasma HIV-1 RNA greater than or equal to 50 copies/mL was assessed at each given time point.

  5. CD4+ T-cell Counts [ Time Frame: Measured at Weeks 24, 48, and 96 ]
    CD4+ T-cell counts were recorded at the given time point

  6. Change in CD4+ T-cell Count [ Time Frame: Measured at Baseline and Weeks 24, 48, and 96 ]
    Changes in CD4+ T-cell count were calculated as the CD4+ T-cell count at a given time point minus the CD4+ T-cell count at Baseline.

  7. CD8+ T-cell Counts [ Time Frame: Measured at Weeks 24, 48, and 96 ]
    CD8+ T-cell counts were recorded at the given time point

  8. Change in CD8+ T-cell Count [ Time Frame: Measured at Baseline and Weeks 24, 48, and 96 ]
    Changes in CD8+ T-cell count were calculated as the CD8+ T-cell count at a given time point minus the CD8+ T-cell count at baseline.

  9. Change in Log10 sCD14 in Plasma at Week 48 From Baseline [ Time Frame: Measured at Baseline and Week 48 ]
    Changes in Log10 sCD14 in Plasma were calculated as the Log10 sCD14 in Plasma at Week 48 minus the Log10 sCD14 in Plasma at Baseline.

  10. Change in Log10 MIP-1 Beta in Plasma at Week 48 From Baseline [ Time Frame: Measured at Baseline and Week 48 ]
    Changes in Log10 MIP-1 Beta in Plasma were calculated as the Log10 MIP-1 Beta in Plasma at Week 48 minus the Log10 MIP-1 Beta in Plasma at Baseline. Results below the lower limit of quantification were set to the lower limit value of 11.

  11. Change in Log10 sTNFr-II in Plasma at Week 48 From Baseline [ Time Frame: Measured at Baseline and Week 48 ]
    Changes in Log10 sTNFr-II in Plasma were calculated as the Log10 sTNFr-II in Plasma at Week 48 minus the Log10 sTNFr-II in Plasma at Baseline.

  12. Change in Log10 VCAM in Plasma at Week 48 From Baseline [ Time Frame: Measured at Baseline and Week 48 ]
    Changes in Log10 VCAM in Plasma were calculated as the Log10 VCAM in Plasma at Week 48 minus the Log10 VCAM in Plasma at Baseline.

  13. Change in Log10 MIP-1 Beta in Cerebrospinal Fluid (CSF) at Week 48 From Baseline [ Time Frame: Measured at Baseline and Week 48 ]
    Changes in Log10 MIP-1 Beta in CSF were calculated as the Log10 MIP-1 Beta in CSF at Week 48 minus the Log10 MIP-1 Beta in CSF at Baseline.

  14. Change in Log10 IP-10 in CSF at Week 48 From Baseline [ Time Frame: Measured at Baseline and Week 48 ]
    Changes in Log10 IP-10 in CSF were calculated as the Log10 IP-10 in CSF at Week 48 minus the Log10 IP-10 in CSF at Baseline.

  15. Change in Log10 Neopterin in CSF at Week 48 From Baseline [ Time Frame: Measured at Baseline and Week 48 ]
    Changes in Log10 Neopterin in CSF were calculated as the Log10 Neopterin in CSF at Week 48 minus the Log10 Neopterin in CSF at Baseline.

  16. Change in Log10 NFL in CSF at Week 48 From Baseline [ Time Frame: Measured at Baseline and Week 48 ]
    Changes in Log10 NFL in CSF were calculated as the Log10 NFL in CSF at Week 48 minus the Log10 NFL in CSF at Baseline.


Other Outcome Measures:
  1. Changes in Cell-associated HIV-1 RNA/DNA/2-long Terminal Repeat Sequences (LTR) Circles and Single Copy Assay (SCA) [ Time Frame: Measured at Baseline and Week 48 ]
    This outcome measure was listed as secondary in the protocol but the intention was as an exploratory outcome due to lack of funding for testing.

  2. Changes in T Cell and Monocyte Activation [ Time Frame: Measured at Baseline and Week 48 ]
    This outcome measure was listed as secondary in the protocol but the intention was as an exploratory outcome due to lack of funding for testing.

  3. Changes in Residual Viremia [ Time Frame: Measured at Baseline and Week 48 ]
    This outcome measure was listed as secondary in the protocol but the intention was as an exploratory outcome due to lack of funding for testing.



Information from the National Library of Medicine

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, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • HIV-1 infection, documented by:

    • a licensed rapid HIV test or HIV enzyme or chemiluminescence immunoassay (E/CIA) test kit at any time prior to study entry and confirmed by a licensed Western blot or a second antibody test by a method other than the initial rapid HIV and/or E/CIA, or by HIV-1 antigen or plasma HIV-1 RNA viral load. NOTE: The term "licensed" refers to a United States Food and Drug Administration (FDA)-approved kit, which is required for all IND studies, or for sites located in countries other than the United States, a kit that has been certified or licensed by an oversight body within that country and validated internally. Non-US sites are encouraged to use US FDA-approved methods for IND studies. WHO (World Health Organization) and CDC (Centers for Disease Control and Prevention) guidelines mandate that confirmation of the initial test result must use a test that is different from the one used for the initial assessment. A reactive initial rapid test should be confirmed by either another type of rapid assay or an E/CIA that is based on a different antigen preparation and/or different test principle (eg, indirect versus competitive), or a Western blot or a plasma HIV-1 RNA. OR
    • Documentation of HIV diagnosis in the medical record by a healthcare provider.
  • On current ART for at least 6 months prior to study entry with no interruption in treatment of greater than or equal to 7 consecutive days. Note: The following ART changes are allowed:

    • Tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide fumarate (TAF)/TAF-containing fixed-dose combination regimens
    • Ritonavir (RTV) to cobicistat (COBI)/COBI-containing fixed-dose combination regimens
  • No plans to change ART while on study. Note: The following planned ART changes are allowed:

    • TDF to TAF/TAF-containing fixed-dose combination regimens
    • RTV to COBI/COBI-containing fixed-dose combination regimens
  • HIV-1 plasma RNA less than 50 copies/mL obtained within 90 days prior to study entry by any FDA-approved assay at any United States laboratory that has a Clinical Laboratory Improvement Amendments (CLIA) certification or its equivalent, or at any network-approved non-US laboratory that operates in accordance with Good Clinical Laboratory Practices (GCLP) and participates in appropriate external quality assurance programs.
  • No more than one HIV-1 plasma RNA greater than or equal to 50 and less than 200 copies/mL (only one "blip") in the past 6 months with a subsequent HIV-1 plasma RNA less than 50 copies/mL. NOTE: There should be no plasma HIV-1 RNA greater than 200 copies/mL within the 6 months prior to study entry.
  • HAND diagnosis (ANI, MND, or HAD) within 60 days prior to study entry. HAND is defined as at least mild impairment on neurocognitive testing (more than one standard deviation below appropriate normative data in two domains of functioning) and no severely confounding factors.
  • Screening laboratory values obtained within 60 days prior to study entry by any US laboratory that has a CLIA certification or its equivalent, or at any network-approved non-US laboratory that operates in accordance with GCLP and participates in appropriate external quality assurance programs:

    • Absolute neutrophil count (ANC) greater than or equal to 500/mm^3
    • Hemoglobin greater than or equal to 7.5 g/dL
    • Platelet count greater than or equal to 40,000/mm^3
    • Creatinine less than or equal to 2.0 x upper limit of normal (ULN)
    • Aspartate transaminase (AST) less than or equal to 5 x ULN
    • Alanine transaminase (ALT) less than 3 x ULN
    • Alkaline phosphatase less than or equal to 5 x ULN
    • Total bilirubin less than 1.5 x ULN. NOTE: If the potential participant is taking an indinavir (IDV)- or atazanavir (ATV)-containing regimen at the time of screening, total bilirubin less than or equal to 5 x ULN is acceptable.
    • Creatinine clearance (CrCl) greater than or equal to 60 mL/min, either measured or estimated by Cockcroft-Gault equation. NOTE: A calculator for estimating the CrCl can be found at www.fstrf.org/ACTG/ccc.html
  • Females of reproductive potential (women who have not been post-menopausal for at least 24 consecutive months, ie, who have had menses within the preceding 24 months, or women who have not undergone surgical sterilization, hysterectomy or bilateral salpingectomy or bilateral oophorectomy or tubal ligation) must have a negative serum or urine pregnancy test by any US clinic or laboratory that has a CLIA certification or its equivalent, or is using a point of care (POC) / CLIA-waived test, or at any network-approved non-US laboratory or clinic that operates in accordance with GCLP and participates in appropriate external quality assurance programs within 48 hours prior to study entry
  • Females of reproductive potential must agree not to participate in the conception process (ie, active attempt to become pregnant, in vitro fertilization), and if participating in sexual activity that could lead to pregnancy, must use at least one reliable form of contraception. Female participants must use contraceptives while receiving study treatment and for 6 weeks after stopping study treatment. More information on this criterion is available in the protocol.
  • Ability and willingness of participant to complete the neuropsychological tests
  • Ability and willingness of participant or a legally authorized representative (see protocol for more information) to provide informed consent
  • Ability and willingness to take oral study medications

Exclusion Criteria:

  • Current or past medical condition(s) that in the opinion of the investigator prevents attribution of the cause of cognitive impairment to HIV. For example:

    • Major depressive disorder with psychotic features
    • Traumatic Brain Injury (TBI) with a clear impact on activities of daily living
    • Developmental delay, intellectual deficit, and/or severe educational disability resulting in some dependence for activities of daily living
    • Ongoing substance use disorder with significant impact on activities of daily living. Difficult or impossible to determine whether cognitive or functional decline is due to substance use or HIV, or both
    • Evidence of intoxication or withdrawal during the screening evaluation
    • Central nervous system (CNS) infections or opportunistic conditions: brain abscess (bacterial, mycobacterial, fungal or Toxoplasma), meningitis with persistent neurologic impairment, primary CNS lymphoma, progressive multifocal leukoencephalopathy (PML), or another structural brain lesion with neurological sequelae
    • Other CNS conditions: non-opportunistic primary or metastatic brain tumors, uncontrolled seizure disorder, progressive multiple sclerosis, stroke with neurological sequelae, or dementia due to causes other than HIV (eg, Alzheimer's disease)
    • Constitutional illness (eg, persistent unexplained fever, diarrhea, significant weight loss, disabling weakness) within 30 days of screening
    • Known untreated B12 deficiency or malnutrition (body mass index [BMI] less than 18) at screening
  • Evidence of current hepatitis C virus infection (HCV) (ie, HCV antibody [Ab] positive within 90 days prior to study entry unless also shown to be plasma HCV RNA negative within the same time period)
  • Unstable and advanced liver disease (as defined by the presence of at least one of the following: ascites, encephalopathy, coagulopathy, hypoalbuminemia, esophageal or gastric varices, or persistent jaundice)
  • Prior or current use of any CCR5 antagonist (such as MVC and cenicriviroc [CVC]) and integrase inhibitor (such as RAL, DTG, and elvitegravir [EVG])
  • Current use of any medication, including antiretrovirals, prohibited in the study (refer to the A5324 protocol-specific web page [PSWP] for the prohibited medications)
  • Breastfeeding
  • Presence of an AIDS-defining opportunistic infection within 6 months prior to entry. Note: Refer to the A5324 Manual of Operations (MOPS) for the list of AIDS-defining opportunistic infections.
  • Active syphilis or treatment for syphilis within 90 days prior to study entry. NOTE: Active syphilis is defined as four-fold increase in serum rapid plasma reagin (RPR) or venereal disease research laboratory (VDRL) tests in an individual with past syphilis, or newly reactive serum RPR or VDRL with a reactive confirmatory test (enzyme immunoassays [EIA] or chemiluminescent assay [CIA], T. pallidum particle agglutination [TP-PA], or fluorescent treponemal antibody absorbed [FTA-ABS]).
  • Known allergy/sensitivity or any hypersensitivity to components of study drugs or their formulation

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): NCT02519777


Locations
Show Show 30 study locations
Sponsors and Collaborators
National Institute of Allergy and Infectious Diseases (NIAID)
Investigators
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Study Chair: Kevin Robertson, PhD University of North Carolina
  Study Documents (Full-Text)

Documents provided by National Institute of Allergy and Infectious Diseases (NIAID):
Statistical Analysis Plan  [PDF] February 12, 2021

Additional Information:
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Responsible Party: National Institute of Allergy and Infectious Diseases (NIAID)
ClinicalTrials.gov Identifier: NCT02519777    
Obsolete Identifiers: NCT02406196
Other Study ID Numbers: A5324
11909 ( Registry Identifier: DAIDS-ES )
First Posted: August 11, 2015    Key Record Dates
Results First Posted: March 2, 2022
Last Update Posted: April 22, 2022
Last Verified: April 2022

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by National Institute of Allergy and Infectious Diseases (NIAID):
HIV-Associated Neurocognitive Disorder
Additional relevant MeSH terms:
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HIV Infections
Blood-Borne Infections
Communicable Diseases
Infections
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Immunologic Deficiency Syndromes
Immune System Diseases
Maraviroc
Dolutegravir
HIV Fusion Inhibitors
Viral Fusion Protein Inhibitors
Molecular Mechanisms of Pharmacological Action
Anti-HIV Agents
Anti-Retroviral Agents
Antiviral Agents
Anti-Infective Agents
CCR5 Receptor Antagonists
HIV Integrase Inhibitors
Integrase Inhibitors
Enzyme Inhibitors