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Impact of Pre-ART Blood CD4+ T Cell Level on the Rectal Reservoir in Long-term HIV-1 Treated Men (VIRECT)

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ClinicalTrials.gov Identifier: NCT02526940
Recruitment Status : Completed
First Posted : August 18, 2015
Last Update Posted : November 1, 2015
Sponsor:
Information provided by (Responsible Party):
Centre Hospitalier Universitaire de Saint Etienne

Study Description
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Brief Summary:
Although combined antiretroviral therapy (cART) has dramatically improved quality of life and lifespan of HIV infected individuals, it still fails to eliminate viral reservoirs. The Gut Associated Lymphoid Tissue (GALT) is the largest reservoir of HIV-1, as it harbors most of HIV target cells as activated memory Cluster of differentiation (CD)4+/CCR5+ T cells. Intestinal T and B cells express α4β7 integrin, a gut mucosal homing receptor which binds to gp120 HIV-1 envelope facilitating the infection of intestinal T cells and the early establishment of the gut HIV reservoir. Intensive viral replication in the GALT leads to an early impairment of mucosal immunity, due to the severe CD4+ T cells depletion, that could be also explained by a lack of recruitment in the gut. Among T cells, interleukin-(IL-)17 secreting CD4+ T cells (Th17) are particularly depleted during HIV infection. This depletion could be associated with HIV progression since these cells play a crucial role in the maintenance of mucosal immunity. A dysbalance of the Th17/Treg ratio may reflect the loss of the intestinal epithelial barrier integrity. These damages are responsible for an increase in microbial translocation, which is associated with immune activation and progression to AIDS. Several recent studies have shown that cART initiation during acute or early HIV-1 infection reduces HIV DNA reservoir size and improves immune reconstitution in blood. Post-treatment controllers, who started long-term cART early after HIV infection, have very low levels of HIV DNA in peripheral blood mononuclear cells, similarly to elite controllers. Unlike most HIV-infected individuals, they maintain an undetectable plasmatic viral load after several years of cART interruption, suggesting that a weak reservoir is a prerequisite to achieve a functional cure. By extrapolation, it could be hypothesized that the gut viral reservoir is also decreased and that mucosal immunity is restored when cART is initiated during primary phase of infection. The gut viral reservoir begins to form within the first days after HIV exposure, and grows during acute HIV infection. Similarly, intestinal T cells are depleted very early after infection, due to high viral replication, host immune response and bystander effects. Most studies also concluded that long-term and optimal treatment can't fully restore mucosal immunity. These observations led us to study the impact of time of cART start on the size of viral reservoir and on immune reconstitution in the gut. For this, we analyzed the virological and immunological characteristics of the rectal HIV reservoir of long-term treated patients regarding their blood CD4+ T cells count at the time of cART initiation.

Condition or disease Intervention/treatment
Human Immunodeficiency Virus Procedure: rectal biopsies Other: Blood samples

Study Design
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Study Type : Observational
Actual Enrollment : 30 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: Impact of Pre- Antiretroviral Therapy (ART) Blood Cluster of Differentiation (CD)4+ T Cell Level on the Rectal Reservoir in Long-term HIV-1 Treated Men
Study Start Date : May 2015
Actual Primary Completion Date : August 2015
Actual Study Completion Date : August 2015

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Biopsy HIV/AIDS

Groups and Cohorts
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Group/Cohort Intervention/treatment
blood CD4 cells count < 200/mm3

patients with blood CD4 cells count at the time of initiation of HAART< 200/mm3.

Six rectal biopsies and blood samples collected for each patient treated by HAART more than 1 year and less than 4 years

 Procedure: rectal biopsies
6 rectal biopsies

Other: Blood samples
Blood samples
blood CD4 cells count : 200 - 300/mm3
patients with blood CD4 cells count at the time of initiation of HAART between 200 and 300/mm3 Six rectal biopsies and blood samples collected for each patient treated by HAART more than 1 year and less than 4 years
 Procedure: rectal biopsies
6 rectal biopsies

Other: Blood samples
Blood samples
blood CD4 cells count >350/mm3

patients with blood CD4 cells count at the time of initiation of HAART> 350/mm3.

Six rectal biopsies and blood samples collected for each patient treated by HAART more than 1 year and less than 4 years

 Procedure: rectal biopsies
6 rectal biopsies

Other: Blood samples
Blood samples


Outcome Measures
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Primary Outcome Measures :
  1. HIV DNA load in rectal biopsies [ Time Frame: day 1 ]
    Comparison of HIV DNA load (copies/106 cells) in rectal biopsies between 3 groups of patients (10 per group) according to their blood CD4 cells count at the time of initiation of Highly Active Antiretroviral Therapy (HAART) : <200, 200-300 and >350/mm3


Secondary Outcome Measures :
  1. HIV DNA load in blood peripheral blood mononuclear cell (PBMC) [ Time Frame: Day 1 ]
    Comparison of HIV DNA load (copies/106 cells) in blood PBMC between 3 groups of patients (10 per group) according to their blood CD4 cells count at the time of initiation of HAART : <200, 200-300 and >350/mm3

  2. HIV RNA load in blood PBMC [ Time Frame: Day 1 ]
    Comparison of HIV RNA load (copies/106 cells) in blood PBMC between 3 groups of patients (10 per group) according to their blood CD4 cells count at the time of initiation of HAART : <200, 200-300 and >350/mm3

  3. HIV RNA load in rectal biopsies [ Time Frame: Day 1 ]
    Comparison of HIV RNA load (copies/106 cells) in rectal biopsies between 3 groups of patients (10 per group) according to their blood CD4 cells count at the time of initiation of HAART : <200, 200-300 and >350/mm3

  4. Cellular composition in rectal biopsies [ Time Frame: Day 1 ]

    Comparison of Cellular composition in rectal biopsies between 3 groups of patients (10 per group) according to their blood CD4 cells count at the time of initiation of HAART : <200, 200-300 and >350/mm3.

    Cellular composition is a outcome measure : expression of CD3, CD4, CD8, CD27, CD45, CCR5 by flow cytometry


  5. Cellular composition in blood PBMC [ Time Frame: Day 1 ]

    Comparison of Cellular composition in blood PBMCbetween 3 groups of patients (10 per group) according to their blood CD4 cells count at the time of initiation of HAART : <200, 200-300 and >350/mm3.

    Cellular composition is a outcome measure : expression of CD3, CD4, CD8, CD27, CD45, CCR5 by flow cytometry



Biospecimen Retention:   Samples Without DNA
blood specimen and rectal biopsies

Eligibility Criteria
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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   Male
Accepts Healthy Volunteers:   No
Sampling Method:   Probability Sample
Study Population
3 groups of men elaborated on the basis of their blood CD4+ T cells count at the time of cART initiation: >350; 350-200; <200, respectively.
Criteria

Inclusion Criteria:

  • Seropositive for HIV
  • Under HAART since at least one and less than 4 years
  • No blood HIV RNA rebound during the therapy
  • Indication of Human Papilloma Virus (HPV) screening by anal rectoscopy
  • Signature of the informed consent form

Exclusion Criteria:

  • Patient under tutelage
  • No signature of the informed consent form
  • No CD4 cell count available at the time of HAART initiation
  • One or several viral rebound(s) during therapy
  • Coinfection by hepatitis B virus (HBV) or hepatitis C virus (HCV)
  • Hemostasis disorders, anticoagulant therapy
  • No medical indication of rectoscopy
  • Inflammatory bowel disease
  • No understanding of the protocol
Contacts and Locations
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Top of Page Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information

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): NCT02526940


Locations
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France
CHU Saint-ETIENNE
Saint-Etienne, France, 42055
Sponsors and Collaborators
Centre Hospitalier Universitaire de Saint Etienne
Investigators
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Principal Investigator: Frederic LUCHT, PhD CHU SAINT-ETIENNE
More Information
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Responsible Party: Centre Hospitalier Universitaire de Saint Etienne
ClinicalTrials.gov Identifier: NCT02526940    
Other Study ID Numbers: 1308020
First Posted: August 18, 2015    Key Record Dates
Last Update Posted: November 1, 2015
Last Verified: October 2015
Keywords provided by Centre Hospitalier Universitaire de Saint Etienne:
Human Immunodeficiency Virus
HIV
HAART
Highly Active antiretroviral therapy
 GALT
Gut Associated Lymphoid Tissue
reservoir
rectum
Additional relevant MeSH terms:
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Acquired Immunodeficiency Syndrome
HIV Infections
Immunologic Deficiency Syndromes
Immune System Diseases
Blood-Borne Infections
Communicable Diseases
Infections
Sexually Transmitted Diseases, Viral
 Sexually Transmitted Diseases
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Slow Virus Diseases
Genital Diseases
Urogenital Diseases