Impact of Raltegravir on HIV-1 cDNA Slope Following Antiretroviral Therapy (ART) Initiation
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ClinicalTrials.gov Identifier: NCT01168167 |
Recruitment Status
:
Completed
First Posted
: July 23, 2010
Last Update Posted
: March 23, 2016
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Recent clinical trials of combination antiretroviral therapy (cART) containing the first approved integrase inhibitor (i.e. raltegravir) have demonstrated a more rapid decay of HIV-1 RNA in plasma, compared to conventional potent antiretroviral combinations. This was observed especially during the early phase (up to week 12) following initiation of cART.
To explain this, two mechanistic hypotheses have been developed:
- - Macrophage reservoir death hypothesis. A major source of virus production during the second phase decay are believed to be long-lived infected cells with continuous virus production - e.g. macrophages. An accumulation of unintegrated, episomal HIV-1 cDNAs can promote apoptosis (Li et al. Embo J. 2001;20: 3272). In case of HIV superinfection of such a productively infected cell, an INI-based cART may induce apoptosis and thus contribute to a decrease in HIV RNA load during second phase decay. However, no study has thus far addressed the consequences of INI treatment on HIV-1 cDNA species on any cell population in vivo.
- - Resting CD4 T-cell reservoir integration block hypothesis. Resting CD4 T-cells may represent a substantial reservoir for HIV replication during the second phase decay as well. A special characteristic of these cells is that HIV-1 cDNA is typically localized to the nucleus in a not-integrated form (Chun et al., PNAS 1997;94:13193). These resting cells likely integrate HIV-DNA upon activation and then contribute to HIV viremia and viral spread. Conceptually, integration could be prevented by RGV, but not by RTI or PI. An accumulation of circular episomal HIV-1 cDNA species may also be a consequence of RGV treatment in this cell type.
Patient disposition:
To explore raltegravir-induced shifts in HIV-1 cDNA species in vivo, this non-interventional clinical observation investigates the dynamics of the three major HIV-1 cDNA species (total HIV-1 cDNA, HIV-1 integrants in the host cell genome, episomal HIV-1 2-LTR circles) over a period of 4 months in two groups of patients starting off cART from a single study center. Patients who begin cART in regular clinical routine with 2N(t)RTI plus either (n=10 patients) raltegravir or (n=10 patients) a boosted protease inhibitor/ alternatively an NNRTI will be offered to participate in this observation. Only patients are offered to participate in this trial if no other antiretroviral drugs than the above mentioned and no concomitant drugs with relevant impact on antiretroviral's pharmacokinetics are administered. At time of study inclusion, patients should be characterised by a HIV-1 RNA load of >5,000 copies/mL and CD4-cell count of >200/µL within 12 weeks before cART initiation.
Preliminary analyses of PBMCs from HIV-infected patients indicate that all three major HIV-1 cDNA species can be quantified by real-time PCR under these baseline conditions.
Condition or disease |
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HIV-1 |
Study Type : | Observational |
Actual Enrollment : | 20 participants |
Observational Model: | Case Control |
Time Perspective: | Prospective |
Official Title: | Comparing the Dynamics of Different HIV-1 cDNA Species in CD4-positive T-cells and HIV-1 RNA in Plasma of Infected Individuals After Initiation of Antiretroviral Therapy With or Without Raltegravir |
Study Start Date : | June 2010 |
Actual Primary Completion Date : | March 2011 |
Actual Study Completion Date : | May 2012 |

Group/Cohort |
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raltegravir-based cART
Patients who begin cART in regular clinical routine with 2N(t)RTI plus raltegravir (n=10 patients) will be offered to participate in this observation arm, but only if no other antiretroviral drugs and no concomitant drugs with relevant impact on antiretroviral's pharmacokinetics are administered. At time of study inclusion, patients should be characterised by a HIV-1 RNA load of >5,000 copies/mL and CD4-cell count of >200/µL within 12 weeks before cART initiation.
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standard of care-cART
Patients who begin cART in regular clinical routine with 2N(t)RTI plus either a boosted protease inhibitor or efavirenz (n=10 patients) at standard doses will be offered to participate in this observation arm. They will be offered to participate in this trial only if no other antiretroviral drugs and no concomitant drugs with relevant impact on antiretroviral's pharmacokinetics are administered. At time of study inclusion, patients should be characterised by a HIV-1 RNA load of >5,000 copies/mL and CD4-cell count of >200/µL within 12 weeks before cART initiation.
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- Dynamical measurement of HIV-1 DNA-species extracted from whole blood-PBMCs [ Time Frame: one year ]
- CD4 cell counts [ Time Frame: one year ]
- plasma-HIV-1 RNA [ Time Frame: one year ]

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Ages Eligible for Study: | 18 Years and older (Adult, Senior) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Sampling Method: | Non-Probability Sample |
Inclusion Criteria:
- Initiation of antiretroviral therapy, consisting of 2 nucleoside/ nucleotide reverse transcriptase inhibitors at physician's disposition plus a third substance, i.e. either raltegravir (n=10 patients) or a standard third substance (efavirenz or boosted protease inhibitor)
- Men or women with a documented HIV-1 infection, treated at the study center
- age at least 18 years old
- physical examination and vital signs, according to the treating physician do not give any hint for a active AIDS-defining illness or other serious disease
- patients are naive to cART or in therapy interruption for at least 3 months
- last available HIV-1 RNA was >5,000 copies/mL within 3 months prior to cART initiation
- last available CD4-cell count showed at least 200 cells/µL within 3 months prior to cART initiation
- according to German-Austrian antiretroviral treatment recommendations, there is a given therapy indication
Exclusion Criteria:
- cART with other than the above mentioned drugs
- administration of concomitant drugs with relevant impact on antiretroviral's pharmacokinetics
- documented problems with patient visit- or medication-adherence
- any condition or disease requiring a medication that may interact relevantly with cART

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): NCT01168167
Germany | |
Johann Wolfgang Goethe-University Hospital | |
Frankfurt, Hessen, Germany, 65520 |
Additional Information:
Study Data/Documents: Study Protocol

Publications of Results:
Responsible Party: | Christoph Stephan, Professor, Johann Wolfgang Goethe University |
ClinicalTrials.gov Identifier: | NCT01168167 History of Changes |
Other Study ID Numbers: |
JWG-HIVCENTER-Hopp1 |
First Posted: | July 23, 2010 Key Record Dates |
Last Update Posted: | March 23, 2016 |
Last Verified: | March 2016 |
Keywords provided by Christoph Stephan, Johann Wolfgang Goethe University:
Antiretroviral Therapy, Highly Active MK 0518 HIV-1 DNA species |
viral slope Ribonucleic Acid DNA, Complementary |
Additional relevant MeSH terms:
Raltegravir Potassium Anti-HIV Agents Anti-Retroviral Agents Antiviral Agents Anti-Infective Agents |
HIV Integrase Inhibitors Integrase Inhibitors Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action |