Use of Combined Antiretroviral Therapy to Determine Sites of Persistent HIV Infection
Status:
Completed
Trial end date:
2010-02-17
Target enrollment:
Participant gender:
Summary
This study will try to define how and where HIV infection persists in the body by
determining: 1) if there are cells where HIV can live for long periods of time without being
seen and destroyed by the immune system; 2) if there are sites where anti-HIV drugs cannot
penetrate enough to stop new HIV replication; and 3) if HIV in certain lymph nodes can remain
infectious for prolonged periods of time. It will also explore whether immune system damage
caused by HIV can be repaired after new virus replication is stopped with treatment.
HIV-infected patients 18 years of age and older may be eligible for this study, which will
include three groups as follows. Candidates will be screened with a medical history, physical
examination, blood and urine tests and possibly chest X-ray and electrocardiogram.
Participants will be divided into three groups according to CD4 count levels: > 500
cells/microliter of blood; between 300 and 500 cells/microliter, and < 300 cells/microliter
of blood. All participants will be treated with a combination of four antiretroviral drugs:
indinavir, zidovudine, lamivudine and nevirapine. (Exceptions to this regimen may be made in
certain circumstances for patients who cannot tolerate one of the four drugs.) In addition,
they will undergo the following procedures:
Blood tests - Blood tests will be done at screening and at study entry to evaluate the
patient's health status and measure CD4 T cell count and plasma HIV levels; at the beginning
of treatment to look for drug-related side effects; and during the course of the study to
evaluate drug effectiveness in inhibiting HIV replication; CD4 T cell levels and function.
Lymph node biopsy - Lymph node biopsies are done under local anesthesia. A small incision is
made, the node is removed, and the incision is closed with stitches. Up to two nodes may be
removed during each procedure. Patients with CD4 counts greater than 500 cells/microliter of
blood and those with counts less than 300 cells/microliter will have three lymph node
biopsies in order to 1) assess the effectiveness of therapy in inhibiting HIV replication in
the nodes (the major site of replication); 2) determine how long HIV-infected cells may
persist in the nodes after new replication is stopped by therapy; and 3) determine if immune
damage caused by HIV can be repaired when virus replication is stopped. Lymph node biopsy in
patients with counts between 300 and 500 cells/microliter of blood is required only at
baseline, although follow-up biopsies are encouraged.
Leukapheresis - In this procedure, whole blood is collected through a needle placed in an arm
vein. The blood circulates through a cell separator machine where the white cells are removed
and collected. The rest of the blood is returned to the body, either through the same needle
used to draw the blood or through a second needle placed in the other arm. The collected
white cells are used for special studies of the level and function of T cells before and
after drug treatment. Patients with CD4 counts > 500 cells/microliter and < 300
cells/microliter will undergo leukapheresis up to four times - at study entry and about 2, 6
and 12 months after starting antiretroviral therapy. Patients with CD4 counts between 300 and
500 cells/microliter will have this procedure either at study entry and 6 and 12 weeks after
initiation therapy, or on the same schedule as the other patients.
Phase:
Phase 1
Details
Lead Sponsor:
National Institute of Allergy and Infectious Diseases (NIAID)