Efficacy of Treatment Intensification With Maraviroc on HIV-1 Viral Latency in Recently Infected Hiv-1 naïve Patients Starting Raltegravir Plus Tenofovir/Emtricitabine - Full Text View

Purpose

The intensification with maraviroc in recently HIV-1-infected patients of a preferred gold-standard triple therapy composed of raltegravir plus tenofovir/emtricitabine could accelerate the decay of the HIV-1 reservoir in latently infected cells established early in HIV-1 infection.

This could provide further insight into this area, decrease the size of latent reservoir, and translate into clinical benefits for patients.

Condition	Intervention	Phase
HIV Infections	Drug: Raltegravir Drug: Maraviroc Drug: Tenofovir/Emtricitabine	Phase 3


Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment
Official Title:	Efficacy of Treatment Intensification With Maraviroc on HIV-1 Viral Latency in Recently Infected Hiv-1 naïve Patients Starting Raltegravir Plus Tenofovir/Emtricitabine.

Resource links provided by NLM:

MedlinePlus related topics: HIV/AIDS

Drug Information available for: Emtricitabine Tenofovir Tenofovir Disoproxil Fumarate Maraviroc Raltegravir Raltegravir potassium

U.S. FDA Resources

Further study details as provided by Germans Trias i Pujol Hospital:

Primary Outcome Measures:

Change at 48 weeks in the slope of decay of integrated and unintegrated viral DNA in PBMCs. [ Time Frame: BL, W2, W4, W12, W24, W48 ] [ Designated as safety issue: No ]

Secondary Outcome Measures:

Decay of residual HIV-1 replication under maraviroc intensification assessed by an ultrasensitive RT-PCR assay with a lower limit of quantification of 5 copies/mL. [ Time Frame: BL, W2, W4, W8, W12, W24, W36, W48 ] [ Designated as safety issue: No ]
Blips during the study (viral load >50 copies/mL, preceded and followed by determinations <50 copies/mL in previous and posterior controls). [ Time Frame: From Baseline to W48 ] [ Designated as safety issue: No ]
HIV-1 RNA below 50 copies/mL at 48 weeks. [ Time Frame: W48 ] [ Designated as safety issue: No ]
Change in the lymphocyte activation marker HLADR+CD38+ from baseline to week 48. [ Time Frame: BL, W4, W12, W24, W48, W60, W72 ] [ Designated as safety issue: No ]
Relationship between maraviroc and/or raltegravir plasma concentrations and change in the slope of decay of integrated viral DNA in PBMCs [ Time Frame: W12, W24, W48 ] [ Designated as safety issue: No ]
HIV-1 specific CTL responses [ Time Frame: BL, W24, W48, W60, W72 ] [ Designated as safety issue: No ]
Plasmatic inflammation biomarkers [ Time Frame: BL, W2, W4, W12, W48, W60 ] [ Designated as safety issue: No ]
RNA, DNA and viral p24 associated to cells in ileum biopsy and PBMC [ Time Frame: W48 ] [ Designated as safety issue: No ]
Lymphocyte activation marker HLADR+CD38+ in ileum biopsy and PBMC [ Time Frame: W48 ] [ Designated as safety issue: No ]
Fibrosis markers in ileum biopsy and PBMC [ Time Frame: W48 ] [ Designated as safety issue: No ]


Enrollment:	30
Study Start Date:	February 2009
Study Completion Date:	November 2011
Primary Completion Date:	November 2011 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: 1 From Baseline to Week48: Raltegravir BID + Tenofovir/Emtricitabine QD + Maraviroc BID From W48 to W72: Raltegravir BID + Tenofovir/Emtricitabine QD	Drug: Raltegravir Raltegravir 400 mg every 12 hours Drug: Maraviroc Maraviroc 300 mg every 12 hours Drug: Tenofovir/Emtricitabine Tenofovir/Emtricitabine 300/200 mg every 24 hours
Active Comparator: 2 Start ARV treatment with : Raltegravir BID + Tenofovir/Emtricitabine	Drug: Raltegravir Raltegravir 400 mg every 12 hours Drug: Tenofovir/Emtricitabine Tenofovir/Emtricitabine 300/200 mg every 24 hours

Detailed Description:

A reservoir of latently infected cells established early in infection may be involved in the maintenance of viral persistence despite continuous highly active antiretroviral therapy (HAART). This is likely to represent the major barrier to virus eradication in patients on successful combination antiretroviral therapy.

The majority of the viruses in the latent reservoir use CCR5 receptor during entry.

More recently, clear evidences for decay of this HIV-1 reservoir in patients who initiated antiretroviral therapy early in infection have been demonstrated. The treatment of acute infection may set the stage for subsequent attempts at eradication. To achieve this, more potent antiretroviral therapy and/or more potent antilatency therapies may be needed.

In contrast to previous antiretroviral drugs, maraviroc does not need to cross the cell membrane, nor does not require intracellular processing in order to exert its activity. In addition, there is no cross-resistance between entry inhibitors and agents that act on intracellular targets.

Maraviroc has demonstrated potent antiviral activity against all CCR5-tropic HIV-1 viruses tested. Maraviroc could thus fulfil the requirements for an optimal candidate for treatment intensification in HIV-1 infected patients with a recent HIV-1 infection.

Eligibility


Ages Eligible for Study:	18 Years and older (Adult, Senior)
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

HIV-1 infected adults (>=18 years old).
No previous antiretroviral therapy for more than 2 weeks.
HIV-1 infection documented in the past 6 months by a previous negative ELISA test, or a documented clinical acute seroconversion in the past 6 months.
CCR5-tropism confirmed at screening.
Voluntary written informed consent.

Exclusion Criteria:

Pregnancy or fertile women willing to be pregnant.
Active substance abuse or major psychiatric disease.
Presence of NRTI mutations in the screening genotype.

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: NCT00808002

Locations


Spain
Hospital Germans Trias i Pujol
Badalona, Barcelona, Spain, 08916
Hospital Clinic i Provincial de Barcelona
Barcelona, Spain, 08916

Sponsors and Collaborators

Germans Trias i Pujol Hospital

Investigators


Principal Investigator:	Bonaventura Clotet, MD,PhD	LLuita contra la SIDA Foundation-HIV Unit
Principal Investigator:	Josep Mª Llibre, MD,PhD	LLuita contra la SIDA Foundation-HIV Unit

More Information


Responsible Party:	Dr . BONAVENTURA CLOTET, Dr. Bonaventura Clotet, Germans Trias i Pujol Hospital
ClinicalTrials.gov Identifier:	NCT00808002 History of Changes
Other Study ID Numbers:	MARAVIBOOST
Study First Received:	December 12, 2008
Last Updated:	September 5, 2014
Health Authority:	Spain: Ministry of Health

Keywords provided by Germans Trias i Pujol Hospital:


Maraviroc CCR5 antagonists Primary HIV Infection	HIV-1 reservoir eradication treatment naive

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 Tenofovir Raltegravir Potassium Emtricitabine	Maraviroc Antiviral Agents Anti-Infective Agents Reverse Transcriptase Inhibitors Nucleic Acid Synthesis Inhibitors Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action Anti-Retroviral Agents Anti-HIV Agents HIV Integrase Inhibitors Integrase Inhibitors CCR5 Receptor Antagonists

ClinicalTrials.gov processed this record on September 23, 2016