HIV-1 Infected Adult Subjects With HIV-associated Neurocognitive Disorders Despite Effective Antiretroviral Therapy

Not Applicable

Completed

• Conditions: HIV-1-infection; HIV Associated Neurocognitive Disorder
• Interventions: Other: Validation of Charter score for the CNS diffusion of antiretroviral drugs

• Registration Number: NCT04266002
• Lead Sponsor: Hôpital Franco-Britannique-Fondation Cognacq-Jay

Brief Summary

Prospective study in HIV-1 infected adult subjects with HIV-associated neurocognitive disorders despite effective antiretroviral therapy in plasma for more than one year, analyzing the evolution of cognitive disorders and markers of macrophagic inflammation in blood and cerebrospinal fluid, after a change in HIV treatment with an increased of the new scale CHARTER score ≥ 3 (total treatment score to be ≥ 9)

Detailed Description

Neurocognitive disorders are measured using Frascati 3-stage classification and Global Deficit Score, after the following 10 standardized battery test: Grooved Pegboard for dominant and non-dominant hand, Grefex Verbal Fluency, California Verbal Learning Test (CVLT), Digit Span Wechsler Adult Intelligence Scale III, modified Paced Auditory Serial Addition Test (60 items), WAIS III Digit Symbol Test, Trail Making Test A\&B, recall of CVLT and Wisconsin Card Sorting Test; and after the Beck Depression Inventory II (BDI), Inventory of Activity Daily Living part II (IADL) and 10-items Cognitive Complaint Questionnaire (CCQ). The global CNS Penetration Effectiveness (CPE) score of ARV treatment are the sum of the scores of each ARV the patient received, according to the last published scoring. For each drug class, we considered treatment intensification only for drugs with CPE score reaching at least 3 (no intensification if switch in same drug class with same CPE score). CPE score was corrected by drugs resistance status, using cumulative genotype interpreted with the 2012 ANRS algorithm (www.hivfrenchresistance.org; v.2012) at inclusion (CPE=0 if resistance).

Study Timeline

• Study Start: 2011-11-01
• Primary Completion: 2012-06-29
• Study Completion: 2016-07-26
• Study First Submitted: 2020-01-24
• Status Verified: 2020-02
• Study First Submitted QC: 2020-02-09
• Last Update Submitted: 2020-02-09
• Study First Posted: 2020-02-12
• Last Update Posted: 2020-02-12

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 31

Inclusion Criteria

1. Subject (male or female) with HIV-1 infection
2. Subject is ≥ 18 years of age
3. Subject with a plasma viral load (HIV-1 RNA) undetectable for at least one year or with minimal replication <500 copies/ml for at least one year at the inclusion date
4. Patient with HIV-associated neurocognitive disorders : at least two ability domains, documented by performance of at least 1.0 standard deviation below the mean for age-education appropriate norms on standardized neuropsychological tests
5. Patient is willing and able to understand and provide written informed consent prior to participation in this study

Exclusion Criteria

1. Subject with HIV-2 infection

2. Subject with plasma viral load (HIV-1 RNA)> 500 copies/ml in the past year

3. Subject with acquired impairment in cognitive functioning involving only one ability domain, or involving at least two ability domains but with performance better than 1.0 standard deviation below the mean (no evidence of potential cognitive impairment)

4. Subject unable, according to the investigator, to meet the study requirements, including patients unable to perform cognitive tests

5. Subject with acute intercurrent disease

6. Patient with positive serology for HCV or HBsAg positive

7. Subject with cognitive impairment related to another cause than HIV: other CNS infection, CNS neoplasm, cerebrovascular disease, preexisting neurologic disease or metabolic disorders, severe substance abuse, or systemic disease.

8. Subject with a brain MRI or CSF analysis results that suggest another pathology than HIV associated neurocognitive disorder

9. Subject requires treatment with immunomodulating agents (or may require such treatment during the two years monitoring) such as systemic corticosteroïds, interferons, interleukins, growth factor GM- CSF, or other targeted therapy that may interfere with macrophage markers of the study

10. Subject requires treatment with radiation therapy or cytotoxic chemotherapeutic agents

11. Subject at which the initial lumbar punction can't be achieved

12. Subject ≥65 years at the inclusion date, age with high risk of atherosclerotic disease

13. Subject with significant depression : with a score ≥29 (or score

    ≥20 without questions 15 to 21) at Beck Depression Inventory II (1996 version), the neuropsychologist doesn't conduct the battery of cognitive tests

14. Subject under curatorship or guardianship

15. Subject at which the initial cerebral MRI can't be achieved

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
HIV-1 infected adult associated neurocognitiv	Validation of Charter score for the CNS diffusion of antiretroviral drugs	HIV-1 infected adult subjects with HIV-associated neurocognitive disorders despite effective antiretroviral therapy in plasma for more than one year, analyzing the evolution of cognitive disorders with Global Deficit Score and HAND classification, and markers of macrophagic inflammation in blood and cerebrospinal fluid, after a change in HIV treatment with an increased of the new scale CHARTER score ≥ 3 (total treatment score to be ≥ 9)

Primary Outcome Measures

Name	Time	Method
Demonstrate a significant improvement in HIV associated neurocognitive disorders after ARV intensification with increased CNS Penetration Effectiveness scoring ≥+3 and total CPE score ≥9.	Change from Baseline to Week 96	HIV associated neurocognitive disorders classification with Frascati 3-stage

Secondary Outcome Measures

Name	Time	Method
To evaluate the evolution of HIV associated neurocognitive disorders with the evolution of markers in CSF: neopterin, neurofilament light chain (NFL), CCL2, IL6, IL8, CXCL10, soluble CD14	Change from Baseline to Week 96	HIV associated neurocognitive disorders are measured with Frascati 3-stage classification and Global Deficit Score. CSF biomarkers were obtained using high-performance liquid chromatography coupled with fluorimetric detection for neopterin (nmol/L), using the Quanterix® single molecule array platform for neurofilament light protein (NF-L)(pg/mL), chemokine (C-C-motif) ligand-2 (CCL2)(pg/mL), interleukine 6 (IL6)(pg/mL), interleukine 8 (IL8)(pg/mL), chemokine (C-X-C-motif) ligand-10 (CXCL10)(pg/mL), and using an enzyme-linked immunosorbent assay (Biotechne®) for soluble CD14 (sCD14)(µg/mL) levels.
Demonstrate a significant improvement in HIV associated neurocognitive disorders after ARV intensification with increased CNS Penetration Effectiveness scoring ≥+3 and total CPE score ≥9.	Change from Baseline to Week 48	HIV associated neurocognitive disorders classification with Frascati 3-stage
To evaluate HIV associated neurocognitive disorders and Global Deficit Score change	Change from Baseline to Week 96	HIV associated neurocognitive disorders are measured with Frascati 3-stage classification. Global Deficit Score (from 0 with no deficit to 5 with high neurocognitive disorder) is calculated with the results of 10 standardized battery tests.
To evaluate the evolution of HIV associated neurocognitive disorders with changes in CD4 and CD8 cells in plasma cells, and plasma HIV-1 viral loads	Change from Baseline to Week 96	HIV associated neurocognitive disorders are measured with Frascati 3-stage classification and Global Deficit Score. CD4 and CD8 cells are measured in plasma with flow cytometry (results in cells/µL).
To evaluate the evolution of HIV associated neurocognitive disorders with plasma HIV-1 viral load cells, and plasma HIV-1 viral loads	Change from Baseline to Week 96	HIV associated neurocognitive disorders are measured with Frascati 3-stage classification and Global Deficit Score. Plasma HIV-1 viral load will be measured with an ultra-sensitive technique with a threshold of 5 copies/mL.
To compare HIV associated neurocognitive disorders in HIV-1 infected patients with detectable and undetectable viral load in CSF	Week 96	HIV associated neurocognitive disorders are measured with Frascati 3-stage classification and Global Deficit Score.Detectable viral load in CSF is defined as a result \>5 copies/mL with ultrasensitive HIV-RNA measure.
To evaluate the patterns of viral genotypic resistance in patients with virologic failure in blood or CSF	Week 96	Virologic failure in the blood is defined as two results \>100 copies/mL within one month. Virologic failure in the CSF is defined as a result \>100 copies/mL
To evaluate regular monitoring of cognitive impairment by Inventory of Activity Daily Living part II to detect at the earliest possible changes in cognitive status	Change from Baseline to Week 96	Inventory of Activity Daily Living part II is altered with a cutoff ≥2
To evaluate the Quality of Life during the study	Change from Baseline to Week 96	Quality of Life is measured by Short Form 36 Health Survey
To compare HIV associated neurocognitive disorders in patients with great CPE change ≥5 and patients with low CPE change (+3 or +4)	Change from Baseline to Week 96	HIV associated neurocognitive disorders are measured with Frascati 3-stage classification and Global Deficit Score. CPE changes are analysed with most recent genotypic algorithm (v.2016)
To evaluate the evolution of HIV associated neurocognitive disorders with the evolution of markers in plasma: neopterin, neurofilament light chain (NFL), CCL2, IL6, IL8, CXCL10, soluble CD14	Change from Baseline to Week 96	HIV associated neurocognitive disorders are measured with Frascati 3-stage classification and Global Deficit Score. Plasma biomarkers were obtained using high-performance liquid chromatography coupled with fluorimetric detection for neopterin (nmol/L), using the Quanterix® single molecule array platform for neurofilament light protein (NF-L)(pg/mL), chemokine (C-C-motif) ligand-2 (CCL2)(pg/mL), interleukine 6 (IL6)(pg/mL), interleukine 8 (IL8)(pg/mL), chemokine (C-X-C-motif) ligand-10 (CXCL10)(pg/mL), and using an enzyme-linked immunosorbent assay (Biotechne®) for soluble CD14 (sCD14)(µg/mL) levels.
To evaluate HIV associated neurocognitive disorders and Brain MRI change	Change from Baseline to Week 96	HIV associated neurocognitive disorders are measured with Frascati 3-stage classification and Global Deficit Score. Brain MRI is performed before and after ARV change
To compare sensitivity and specificity of the 2 screening tests (FAB test and Modified - HIV Dementia Scale) for the diagnosis of HAND	Day 0	HIV associated neurocognitive disorders are measured with Frascati 3-stage classification and Global Deficit Score. Altered Frontal Assessment Battery test is defined with a score ≤15/18 and altered modified-HIV Dementia Scale screening test is defined with a score ≤10/12.
To evaluate regular monitoring of cognitive impairment by 10-items Cognitive Complaint Questionnaire to detect at the earliest possible changes in cognitive status	Change from Baseline to Week 96	10-items Cognitive Complaint Questionnaire is altered with a cutoff ≥3
To study the cardiovascular risk evolution	Change from Baseline to Week 96	Cardiovascular risk is measured with Framingham score, Systematic Coronary Risk Estimation, and D:A:D study model score are calcul
To study the incidence and severity of adverse events during the study period	Week 96	Neurologic or neuropsychologic adverse events are particularly analysed
To study the trough levels of antiretroviral drugs in blood and cerebrospinal fluid during the study	Week 96	ARV concentrations were determined using an ultra-performance liquid chromatography coupled with tandem mass spectrometry
To study the trough levels of antiretroviral drugs in blood after ARV change	Week 4	ARV concentrations were determined using an ultra-performance liquid chromatography coupled with tandem mass spectrometry

Trial Locations

Locations (12)

Hôpital d'Argenteuil; 🇫🇷 Argenteuil, France

Hôpital Intercommunal Robert Ballanger; 🇫🇷 Aulnay-sous-Bois, France

Centre Hospitalier de Bligny; 🇫🇷 Briis-sous-Forges, France

Hôpital Mignot Centre Hospitalier de Versailles; 🇫🇷 Chesnay, France

Centre Hospitalier René Dubois; 🇫🇷 Pontoise, France

Hôpital Raymond Poincaré; 🇫🇷 Garches, France

Centre Hospitalier Marc Jacquet; 🇫🇷 Melun, France

Centre Hospitalier de Gonesse; 🇫🇷 Gonesse, France

Institut Hospitalier Franco- Britannique; 🇫🇷 Levallois-Perret, France

Hôpital Delafontaine; 🇫🇷 Saint-Denis, France

Centre Hospitalier Intercommunal de Poissy Germain en Laye; 🇫🇷 Saint-Germain-en-Laye, France

Hôpital Foch; 🇫🇷 Suresnes, France