Making an Early Diagnosis of Talaromycosis Using a Novel Antigen Test

Active, not recruiting

• Conditions: AIDS/HIV - RelatedDisease Associated With AIDS

• Registration Number: NCT04033120
• Lead Sponsor: Duke University

Brief Summary

This is a research study to determine whether a new antigen detection test called Mp1p EIA can make an early diagnosis of talaromycosis from the blood and urine of patients. Talaromycosis is a life-threatening infection caused by a fungus endemic in Southeast Asia commonly found in patients with advanced HIV disease called Talaromyces marneffei.

Detailed Description

This study aims to determine the diagnostic and prognostic values and the clinical impact of Talaromyces marneffei antigenemia (TmAg) in patients with advanced HIV disease using a novel enzyme immunoassay (EIA) detecting Tm-specific cell wall mannoprotein Mp1p. The data generated will be used to inform the design of future diagnostic clinical trials to test the utility of screening and providing pre-emptive antifungal therapy to prevent disease and reduce HIV mortality in Southeast Asia.

The primary objective is to screen for TmAg and determine its diagnostic and prognostic performance in symptomatic and asymptomatic HIV-infected patients with a CD4 count ≤100 cells/mm3.

We will test the following hypotheses:

1. In symptomatic hospitalized patient Cohort 1, the sensitivity of the Mp1p EIA will be higher than conventional culture method while simultaneously specificity is higher than 95% for diagnosing culture-confirmed talaromycosis over a six-month follow up period

2. In asymptomatic outpatient Cohort 2, there will be at least 30% difference in risk of talaromycosis development in TmAg-positive patients compared to TmAg-negative patients over a twelve-month follow up period

3. TmAg concentration predicts development of talaromycosis

Secondary Objectives include:

1. To assess the impact of presence of TmAg on clinical outcomes, including development of culture-confirmed talaromycosis, incidence of state III and IV AIDS events, subsequent hospitalizations, and death over six- to twelve-month follow up periods

2. To compare the diagnostic values of the Mp1p EIA when performed in plasma, sera, and urine samples and when performed in these matrices in combination

We will test the following hypotheses:

3. To model the health economic benefits of screening and pre-emptive treatment for pre-clinical infection

4. To assess impact on clinic outcomes of screening all patients for cryptococcosis and histoplasmosis

5. To collect additional blood samples and store left-over samples for future research to validate infectious disease diagnostics and research to understand genetic susceptibility to infectious diseases relevant to HIV population

Participants in the study, will be asked questions about their medical and travel history. Participants will have blood and urine collected for the Mp1p EIA test to look for early talaromycosis infection and for other tests to look for common HIV-associated infections including tuberculosis, cryptococcosis, and histoplasmosis. They will be examined by a study doctor at least once weekly if they are in the hospital and will be followed in clinic monthly for between 6 and 12 months.

Study Timeline

• Study First Submitted: 2019-07-23
• Study First Submitted QC: 2019-07-23
• Study First Posted: 2019-07-25
• Study Start: 2021-02-22
• Status Verified: 2024-02
• Last Update Submitted: 2024-02-14
• Last Update Posted: 2024-02-15
• Primary Completion: 2024-12-31
• Study Completion: 2024-12-31

Recruitment & Eligibility

• Status: ACTIVE_NOT_RECRUITING
• Sex: All
• Target Recruitment: 1400

Inclusion Criteria

1. HIV-1 infection (at least 2 of 3 HIV antibody tests are positive), AND
2. HIV-infected age ≥18 years, AND
3. CD4 count ≤100 cells/mm3 within the past 3 months, AND
4. Antiretroviral therapy (ART) naïve OR recent ART ≤3 months OR suspected or confirmed treatment failure on ART ≥12 months (defined as poor treatment adherence, treatment interruption, or having a confirmed HIV RNA ≥1,000 copies)
5. Cohort 1: suspected to have an active infection
6. Cohort 2: not suspected to have or being evaluated for an active infection

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Exclusion Criteria

1. Unlikely to attend regular clinic visits
2. History of recent talaromycosis or histoplasmosis infection currently on antifungal therapy

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Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Incidence of microscopy and/or culture-confirmed talaromycosis	over six to twelve months	Cumulative incidence of microscopic and or culture-confirmed talaromycosis over six to twelve months will be recorded

Secondary Outcome Measures

Name	Time	Method
Incidence of stage III and IV AIDS events	over six to twelve months	Cumulative incidence of HIV stage III and IV event according to WHO criteria
Incidence of loss to follow up	over six to twelve months	Loss of follow up is defined as missing \>3 consecutive clinic visits
Mortality in the subsequent six months (Cohort 1) and twelve months (Cohort 2)	over six to twelve months	All cause mortality will be recorded
Hospitalizations in the subsequent six to twelve months	over six to twelve months	Cumulative incidence of hospitalizations
Incidence of other major HIV-associated opportunistic infections	over six to twelve months	Opportunistic infections to be recorded include: tuberculosis, cryptococcosis, and histoplasmosis

Trial Locations

Locations (2)

National Hospital for Tropical Diseases; 🇻🇳 Hà Nội, Vietnam

Hospital for Tropical Diseases; 🇻🇳 Ho Chi Minh City, Ward 1 District 5, Vietnam