Raltegravir Cerebrospinal Fluid Pharmacodynamic Study in HIV-Infected Individuals
试验速览
- 阶段
- 不适用
- 状态
- 终止
- 入组人数
- 2
- 试验地点
- 1
- 主要终点
- Cerebrospinal Fluid HIV RNA Levels
研究概览
简要总结
The primary aim of this study is to determine the effects of the HIV integrase inhibitor, raltegravir, in cerebrospinal fluid (CSF). This will be accomplished by collecting CSF before and after initiation of either raltegravir or another antiretroviral, efavirenz, each in combination with two other antiretrovirals. Assessments will include HIV RNA levels (viral load), neuropsychological testing, mood assessments, and quality of life assessments.
详细描述
Cognitive disorders continue to be a common complication of HIV disease even though potent antiretroviral drugs can reduce HIV below detectable levels and restore immune function. Concentrations of most antiretrovirals in the nervous system are only a fraction of concentrations in blood. As a result, HIV can continue to be present in the nervous system when it is below detection in blood. A recently approved drug, raltegravir, reaches therapeutic concentrations in cerebrospinal fluid and may be effective at controlling HIV replication in the primary target cells in the brain, macrophages and microglia. Based on this, raltegravir may be a particularly effective drug for treating HIV disease in the nervous system. The purpose of this study is to determine the effects of raltegravir in the nervous system by measuring HIV in the CSF (via lumbar puncture, also known as spinal taps) before and after initiation of raltegravir-containing antiretroviral therapy. CSF is an accessible fluid that provides a window into brain processes, including HIV replication and inflammation. The potency of raltegravir will be estimated by calculating the change in HIV viral load in CSF over time. These changes will be compared to those following initiation an efavirenz-containing regimen in a separate group of individuals. Two additional drugs (tenofovir disoproxil fumarate, emtricitabine) will be combined with either raltegravir or efavirenz. Neuropsychological performance, mood, sleep and quality of life assessment will also be compared. Participants will be randomly assigned to either raltegravir- or efavirenz-containing therapy.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 65 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Men and women aged 18-65 years;
- •Integrase inhibitor-naive subjects with clinical indication to initiate RAL under the supervision of their HIV care provider;
- •Baseline detectable HIV-1 RNA levels ≥ 5000 copies/mL in plasma and ≥ 500 copies/mL in CSF;
- •Absolute T-cell CD4+ subset between 200-500/mm3
- •Individual willing to undergo serial lumbar punctures as outlined in study evaluations;
- •Subject able to give informed consent to all study procedures (if cognitively impaired, the individual must pass an evaluation to ensure adequate comprehension of the consent document and procedures);
- •Susceptibility to all study drugs on Monogram Biosciences PhenoSense GT assay.
排除标准
- •Contraindication to lumbar puncture, such as current coagulopathy, thrombocytopenia (platelets below 50,000/µL), or use of anticoagulants;
- •Cognitive, psychiatric, or substance use disorders or any other medical conditions that would interfere with study participation, in the opinion of the investigator;
- •Major opportunistic infections (e.g., pneumonia, tuberculosis) within 30 days;
- •Use of prescribed drugs with known substantial interactions with the study drugs;
- •Positive HCV serology;
- •HIV-associated dementia/Global Deterioration Scale ≥4;
- •Serum creatinine higher than 2.0 mg/dL;
- •Total bilirubin or alanine or aspartate transaminases more than 3 times the upper limit of normal
研究组 & 干预措施
Raltegravir
干预措施: Raltegravir (Drug)
Efavirenz
干预措施: Efavirenz (Drug)
结局指标
主要结局
Cerebrospinal Fluid HIV RNA Levels
时间窗: 180 days
Slope of decline of HIV RNA levels in CSF over time
次要结局
- Neuropsychological Performance(180 days)
- Measure of Sleep(180 days)
- Measure of Quality of Life(180 days)
- Measure of Mood(180 days)
研究者
Scott Letendre
Associate Professor of Medicine
University of California, San Diego