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Adding Maraviroc to Antiretroviral Therapy for Suboptimal CD4 T-Cell Recovery Despite Sustained Virologic Suppression

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ClinicalTrials.gov Identifier: NCT00709111
Recruitment Status : Completed
First Posted : July 3, 2008
Results First Posted : February 24, 2012
Last Update Posted : February 3, 2016
Sponsor:
Collaborator:
National Institute of Allergy and Infectious Diseases (NIAID)
Information provided by (Responsible Party):
AIDS Clinical Trials Group

Study Description
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Brief Summary:
Despite viral suppression, antiretroviral therapy (ART) does not restore CD4+ T-cell counts in some subjects. The purpose of this study is to assess whether adding maraviroc (MVC) to a suppressive ART will result in a significant CD4+ T-cell count increase over 24 weeks in subjects with suboptimal CD4+ T-cell recovery despite sustained virologic suppression.

Condition or disease Intervention/treatment Phase
HIV Infections Drug: Maraviroc Not Applicable

Detailed Description:

The majority of HIV-infected subjects with virologic suppression on antiretroviral therapy (ART) have a marked increase in CD4+ T-cell counts over the first year on treatment. However, a portion of these individuals show a suboptimal immune response and remain at an elevated risk for disease progression. The use of the CCR5 inhibitor maraviroc (MVC) is associated with enhanced CD4+ T-cell recovery in subjects who initiate ART. AIDS Clinical Trials Group (ACTG) A5256 studied the effect of ART intensification with MVC on CD4+ T-cell counts in subjects with suboptimal CD4 recovery despite sustained virologic suppression. Eligible subjects added MVC to their ART regimen, and continued MVC for 24 weeks. At week 24, subjects discontinued MVC and were followed for an additional 24 weeks off MVC.

Subjects were seen through week 48 for clinical and laboratory evaluations, including plasma HIV-1 RNA, CD4+ T-cell count, and safety laboratories. Subjects had 2 baseline visits prior to starting MVC. Study visits were scheduled at weeks 4, 8, 12, 16, 22, 24, 36, 46, and 48. CD4+ T-cell counts were measured at every study visit and HIV-1 RNA at weeks 12, 24, 36, and 48, regardless of treatment status. Measures of activation, T-cell maturation, and apoptosis were performed at all weeks except 4, 8, and 16. At the end of the study, the pre-entry, entry, week 12, 22, 24, and 36 samples for the HIV-1 RNA by single-copy assay (SCA) were run. The week 46 and 48 samples were not run.


Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 34 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Pilot Trial of Maraviroc for Treatment of Subjects on Antiretroviral Therapy With Suboptimal CD4 T-cell Count Recovery Despite Sustained Virologic Suppression
Study Start Date : January 2009
Actual Primary Completion Date : October 2009
Actual Study Completion Date : April 2010

Resource links provided by the National Library of Medicine

MedlinePlus related topics: HIV/AIDS
Drug Information available for: Maraviroc
U.S. FDA Resources

Arms and Interventions
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Arm Intervention/treatment
Experimental: Maraviroc
Maraviroc (MVC) was taken for 24 weeks, in addition to the subject's current antiretroviral therapy (ART) drug regimen. At week 24, subjects discontinued MVC and were followed for an additional 24 weeks off MVC, but still on current ART drug regimen.
 Drug: Maraviroc
The maraviroc doses were 150 mg orally twice daily, 300 mg orally twice daily, or 600 mg orally twice daily, depending on the pharmacokinetic interaction with a subject's pre-study ART and non-ART drug regimen according to the package insert.
Other Names:
  • MVC
  • Selzentry


Outcome Measures
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Primary Outcome Measures :
  1. Change in CD4+ T-cell Count [ Time Frame: From baseline to week 24 ]
    Change was calculated as the week 24 CD4+ T-cell count (average of the week 22 and week 24 values) minus the baseline CD4+ T-cell count (average of pre-entry and entry values).


Secondary Outcome Measures :
  1. Proportion of Participants Achieving a 50-cell Increase in CD4+ T-cell Count [ Time Frame: From baseline to week 24 ]
    Baseline was defined as the average of pre-entry and entry values. Week 24 was defined as the average of the week 22 and week 24 values.

  2. Within-subject CD4+ T-cell Count Slopes [ Time Frame: From baseline through week 24 ]
    The estimated mean slope was summarized across the population by using generalized estimating equations. Baseline was defined as the average of pre-entry and entry values. Week 24 was defined as the average of the week 22 and week 24 values.

  3. Change From Within-subject Pre-treatment CD4+ T-cell Count Slopes to Corresponding Within-subject CD4+ T-cell Count Slopes From Baseline Through Week 24 [ Time Frame: From pre-treatment through week 24 ]
    The estimated mean change in slopes was summarized across the population by using generalized estimating equations. Pre-treatment CD4+ T-cell counts (from at least 48 weeks prior to study entry) were recorded at screening from patient source documentation. Baseline was defined as the average of pre-entry and entry values. Week 24 was defined as the average of the week 22 and week 24 values.

  4. Change in CD4+ T-cell Count [ Time Frame: From week 24 to week 36 ]
    Change was calculated as week 36 CD4+ T-cell count minus the week 24 CD4+ T-cell count (average of the week 22 and week 24 values).

  5. Change in CD4+ T-cell Count [ Time Frame: From week 24 to week 48 ]
    Change was calculated as week 48 CD4+ T-cell count (average of week 46 and week 48) minus the week 24 CD4+ T-cell count (average of the week 22 and week 24 values).

  6. Change in CD4 Percentage [ Time Frame: From baseline to week 24 ]
    Change was calculated as the week 24 CD4 percentage (average of the week 22 and week 24 values) minus the baseline CD4 percentage (average of pre-entry and entry values).

  7. Within-subject CD4 Percentage Slopes [ Time Frame: From baseline through week 24 ]
    The estimated mean slope was summarized across the population by using generalized estimating equations. Baseline was defined as the average of pre-entry and entry values. Week 24 was defined as the average of the week 22 and week 24 values.

  8. Change From Within-subject Pre-treatment CD4 Percentage Slopes to Corresponding Within-subject CD4 Percentage Slopes From Baseline Through Week 24 [ Time Frame: From pre-treatment through week 24 ]
    The estimated mean change in slopes was summarized across the population by using generalized estimating equations. Pre-treatment CD4 percentage (from at least 48 weeks prior to study entry) were recorded at screening from patient source documentation. Baseline was defined as the average of pre-entry and entry values. Week 24 was defined as the average of the week 22 and week 24 values.

  9. Change in CD4 Percentage [ Time Frame: From week 24 to week 36 ]
    Change was calculated as week 36 CD4 percentage minus the week 24 CD4 percentage (average of the week 22 and week 24 values).

  10. Change in CD4 Percentage [ Time Frame: From week 24 to week 48 ]
    Change was calculated as week 48 CD4 percentage (average of week 46 and week 48) minus the week 24 CD4 percentage (average of the week 22 and week 24 values).

  11. Number of Subjects Who Experience a Grade 2, 3 or 4 Signs and Symptoms, Grade 3 or 4 Laboratory Abnormalities, or Death. [ Time Frame: From baseline through week 24 ]
    Events with date of onset or specimen date prior to first dose of MVC or after the last dose of MVC were excluded. Signs and symptoms with a date of onset the same as the first dose of MVC were excluded if confirmed by the site to be before the first dose. Lab abnormalities with the date of specimen the same as the date of the first dose of MVC were excluded on the assumption that the specimen was drawn before the first dose. Grading used the Division of AIDS (DAIDS) 2004 Severity of Adverse Events Tables, where Grade 1=Mild, 2=Moderate, 3=Severe, 4=Potentially life-threatening.

  12. Change in Percentage of CD4+ T-cells That Are: naïve (%CD45RA+CCR7+), Central Memory (%CD45RA-CCR7+), Effector Memory (%CD45RA-CCR7-), Effector (%CD45RA+CCR7-), %HLA-DR+CD38+, %CD38+, %Ki67+, %caspase3+, %Bcl-2-, and %CD57+ [ Time Frame: From baseline to week 24 ]
    Change was calculated as the week 24 result (average of the week 22 and week 24 values) minus the baseline result (average of pre-entry and entry values).

  13. Change in Percentage of CD8+ T-cells That Are: naïve (%CD45RA+CCR7+), Central Memory (%CD45RA-CCR7+), Effector Memory (%CD45RA-CCR7-), Effector (%CD45RA+CCR7-), %HLA-DR+CD38+, %CD38+, %Ki67+, %caspase3+, %Bcl-2-, and %CD57+ [ Time Frame: From baseline to week 24 ]
    Change was calculated as the week 24 result (average of the week 22 and week 24 values) minus the baseline result (average of pre-entry and entry values).

  14. Change in Percentage of CD4+ T-cells That Are: naïve (%CD45RA+CCR7+), Central Memory (%CD45RA-CCR7+), Effector Memory (%CD45RA-CCR7-), Effector (%CD45RA+CCR7-), %HLA-DR+CD38+, %CD38+, %Ki67+, %caspase3+, %Bcl-2-, and %CD57+ [ Time Frame: From week 24 to week 36 ]
    Change was calculated as week 36 result minus the week 24 result (average of the week 22 and week 24 values).

  15. Change in Percentage of CD8+ T-cells That Are: naïve (%CD45RA+CCR7+), Central Memory (%CD45RA-CCR7+), Effector Memory (%CD45RA-CCR7-), Effector (%CD45RA+CCR7-), %HLA-DR+CD38+, %CD38+, %Ki67+, %caspase3+, %Bcl-2-, and %CD57+ [ Time Frame: From week 24 to week 36 ]
    Change was calculated as week 36 result minus the week 24 result (average of the week 22 and week 24 values).

  16. Change in Percentage of CD4+ T-cells That Are: naïve (%CD45RA+CCR7+), Central Memory (%CD45RA-CCR7+), Effector Memory (%CD45RA-CCR7-), Effector (%CD45RA+CCR7-), %HLA-DR+CD38+, %CD38+, %Ki67+, %caspase3+, %Bcl-2-, and %CD57+ [ Time Frame: From week 24 to week 48 ]
    Change was calculated as week 48 result (average of week 46 and week 48) minus the week 24 result (average of the week 22 and week 24 values).

  17. Change in Percentage of CD8+ T-cells That Are: naïve (%CD45RA+CCR7+), Central Memory (%CD45RA-CCR7+), Effector Memory (%CD45RA-CCR7-), Effector (%CD45RA+CCR7-), %HLA-DR+CD38+, %CD38+, %Ki67+, %caspase3+, %Bcl-2-, and %CD57+ [ Time Frame: From week 24 to week 48 ]
    Change was calculated as week 48 result (average of week 46 and week 48) minus the week 24 result (average of the week 22 and week 24 values).

  18. Change in Soluble CD14 [ Time Frame: From baseline to week 24 ]
    Change was calculated as the week 24 result (average of the week 22 and week 24 values) minus the baseline result (average of pre-entry and entry values). Soluble CD14 is a marker of gut microbial translocation.

  19. Change in Soluble CD14 [ Time Frame: From week 24 to week 36 ]
    Change was calculated as week 36 result minus the week 24 result (average of the week 22 and week 24 values). Soluble CD14 is a marker of gut microbial translocation.

  20. Change in Soluble CD14 [ Time Frame: From week 24 to week 48 ]
    Change was calculated as week 48 result (average of week 46 and week 48) minus the week 24 result (average of the week 22 and week 24 values). Soluble CD14 is a marker of gut microbial translocation.

  21. Change in High Sensitivity C-reactive Protein (Hs-CRP) [ Time Frame: From baseline to week 24 ]
    Change was calculated as the week 24 result (average of the week 22 and week 24 values) minus the baseline result (average of pre-entry and entry values).

  22. Change in Interleukin (IL)-6, Monocyte Chemoattractant Protein (MCP)-1, MCP-2, and Plasma CD40 Ligand (CD40L) [ Time Frame: From baseline to week 24 ]
    Change was calculated as the week 24 result (average of the week 22 and week 24 values) minus the baseline result (average of pre-entry and entry values).

  23. Change in Intercellular Cell Adhesion Molecule (ICAM)-1, Plasma P-selectin, Soluble TNFRII (sTNFRII), and Matrix Metalloproteinase (MMP)-9 [ Time Frame: From baseline to week 24 ]
    Change was calculated as the week 24 result (average of the week 22 and week 24 values) minus the baseline result (average of pre-entry and entry values).

  24. Change in D-dimer [ Time Frame: From baseline to week 24 ]
    Change was calculated as the week 24 result (average of the week 22 and week 24 values) minus the baseline result (average of pre-entry and entry values).

  25. Change in Hs-CRP [ Time Frame: From week 24 to week 36 ]
    Change was calculated as week 36 result minus the week 24 result (average of the week 22 and week 24 values).

  26. Change in IL-6, MCP-1, MCP-2, and Plasma CD40L [ Time Frame: From week 24 to week 36 ]
    Change was calculated as week 36 result minus the week 24 result (average of the week 22 and week 24 values).

  27. Change in ICAM-1, Plasma P-selectin, sTNFRII, and MMP-9 [ Time Frame: From week 24 to week 36 ]
    Change was calculated as week 36 result minus the week 24 result (average of the week 22 and week 24 values).

  28. Change in D-dimer [ Time Frame: From week 24 to week 36 ]
    Change was calculated as week 36 result minus the week 24 result (average of the week 22 and week 24 values).

  29. Change in Hs-CRP [ Time Frame: From week 24 to week 48 ]
    Change was calculated as week 48 result (average of week 46 and week 48) minus the week 24 result (average of the week 22 and week 24 values).

  30. Change in IL-6, MCP-1, MCP-2, and Plasma CD40L [ Time Frame: From week 24 to week 48 ]
    Change was calculated as week 48 result (average of week 46 and week 48) minus the week 24 result (average of the week 22 and week 24 values).

  31. Change in ICAM-1, Plasma P-selectin, sTNFRII, and MMP-9 [ Time Frame: From week 24 to week 48 ]
    Change was calculated as week 48 result (average of week 46 and week 48) minus the week 24 result (average of the week 22 and week 24 values).

  32. Change in D-dimer [ Time Frame: From week 24 to week 48 ]
    Change was calculated as week 48 result (average of week 46 and week 48) minus the week 24 result (average of the week 22 and week 24 values).

  33. Proportion of Participants With Detectable HIV-1 Viremia as Measured by Single Copy Assay (SCA) [ Time Frame: At weeks -1 (pre-entry), 0 (entry), 12, 22, 24, and 36 ]
    A subject was considered detectable at a specific week if HIV-1 RNA by SCA >=1 copy/ml.

  34. Drug Adherence Assessed as Number of Missed Doses Over a 4-day Recall [ Time Frame: At weeks 4, 12, and 24 ]
    Self-reported MVC adherence data were based on a four-day (8 expected doses) recall. Based on the wording of the Self Report case report form (CRF), participants reporting that they were currently taking MVC that then failed to complete the record of the number of missed doses were assumed to have no missed doses to report. Missing adherence assessments at a time point of interest were ignored and only those participants completing an adherence assessment at least one time point of interest were included.


Eligibility Criteria
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Ages Eligible for Study:   16 Years and older   (Child, Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • HIV-1 infection
  • On ART for at least 48 weeks prior to study entry with a regimen that includes three or more antiretroviral medications
  • No change in ART regimen for at least 24 weeks prior to study entry
  • Screening CD4+ T-cell count less than 250 obtained within 60 days prior to study entry
  • Stable CD4+ T-cell count for at least 48 weeks prior to study entry (as assessed by an estimated CD4+ T-cell count slope between -20 and +20 cells/year)
  • Screening HIV-1 RNA below the limit of detection using an FDA-approved assay obtained within 60 days prior to study entry
  • All other plasma HIV-1 RNA measurements in the 48 weeks prior to study entry must be below the limit of detection

  • Laboratory values obtained within 60 days prior to study entry:

    • Absolute neutrophil count (ANC) >=750/µL
    • Hemoglobin >=9.0 g/dL for female subjects and >=10.0 g/dL for male subjects
    • Platelet count >=50,000/ µL
    • Calculated creatinine clearance (CrCl) >=30 mL/min
    • Aspartate aminotransferase (serum glutamic oxaloacetic transaminase), alanine aminotransferase (serum glutamic pyruvic transaminase), and alkaline phosphatase <=5 X Upper Limit of Normal (ULN)
    • Direct bilirubin <=2.5 X ULN
  • Females of reproductive potential will need a negative serum or urine pregnancy test within 48 hours prior to study entry
  • Agree not to participate in the conception process, and if participating in sexual activity that could lead to pregnancy, the subject/partner must use at least two reliable forms of contraceptives while receiving study treatment and for 6 weeks after stopping study treatment.

Exclusion Criteria:

  • Unstable clinical condition
  • Currently breast-feeding or pregnant
  • Use of immunomodulators or cancer chemotherapy or radiation treatment within 12 months prior to study entry
  • An acute AIDS-defining illness within 60 days prior to study entry
  • Known allergy/sensitivity or hypersensitivity to components of MVC, including allergy or hypersensitivity to soya lecithin, soya or peanuts
  • Active drug or alcohol abuse that, in the opinion of the investigator, would interfere with adherence to study regimens
  • Serious illness requiring systemic treatment and/or hospitalization within 60 days prior to study entry
  • Receipt of a vaccine within 30 days prior to study entry
  • Current or previous use of a CCR5 inhibitor
  • Plan to change background ART regimen within 24 weeks after study entry
  • Receipt of experimental or non-experimental medications for the purpose of raising CD4+ T-cell counts within 6 months prior to study entry
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): NCT00709111


  Show 29 Study Locations
Sponsors and Collaborators
AIDS Clinical Trials Group
National Institute of Allergy and Infectious Diseases (NIAID)
Investigators
Study Chair: Timothy J. Wilkin, MD, MPH Cornell Clinical Research Site
Study Chair: Roy Gulick, MD, MPH Cornell HIV Clinical Trials Unit
More Information
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Publications of Results:
Wilkin T, Lalama C, Tenorio A, Landay A, Ribaudo H, McKinnon J, Gandhi R, Mellors J, Currier J, and Gulick R. Maraviroc Intensification for Suboptimal CD4+ Cell Response Despite Sustained Virologic Suppression: ACTG 5256. 17th Conference on Retroviruses and Opportunistic Infections, San Francisco, CA, February 16-19, 2010.
Wilkin T, Lalama C, Tenorio A, Landay A, Fox L, McKinnon J, Gandhi R, Mellors J, Currier J, Gulick R. ACTG 5256: Effect of adding and removing maraviroc (MVC) on immune activation in participants on suppressive antiretroviral therapy (ART). 18th Conference on Retroviruses and Opportunistic Infections, Boston, MA, February 27-March 02, 2011.
Hilldorfer B, Lalama C, McKinnon J, Coombs B, Tenorio A, Fox L, Gandhi R, Ribaudo H, Currier J, Gulick R, Wilkin TJ, Mellors J. Effects of Maraviroc (MVC) on Residual Low-Level Viremia in Patients on Suppressive Antiretroviral Therapy (ART): Results from ACTG 5256. 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention, Rome, Italy, July 17-20, 2011.

Other Publications:

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

Responsible Party: AIDS Clinical Trials Group
ClinicalTrials.gov Identifier: NCT00709111     History of Changes
Other Study ID Numbers: ACTG A5256
1U01AI068636 ( U.S. NIH Grant/Contract )
First Posted: July 3, 2008    Key Record Dates
Results First Posted: February 24, 2012
Last Update Posted: February 3, 2016
Last Verified: January 2016

Keywords provided by AIDS Clinical Trials Group:
CCR5 antagonist
CD4 T-cell count
immune activation
treatment experienced

Additional relevant MeSH terms:
HIV Infections
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Immunologic Deficiency Syndromes
 Immune System Diseases
Maraviroc
CCR5 Receptor Antagonists
Molecular Mechanisms of Pharmacological Action
Anti-HIV Agents
Anti-Retroviral Agents
Antiviral Agents
Anti-Infective Agents