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Valproic Acid and Its Effects on HIV Latent Reservoirs

Primary Purpose

HIV Infections

Status
Completed
Phase
Phase 2
Locations
Canada
Study Type
Interventional
Intervention
Valproic Acid
HAART
Sponsored by
Jean-Pierre Routy
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for HIV Infections focused on measuring HIV infections, Histone deacetylase Inhibitor, HIV Reservoirs, Peripheral Blood Mononuclear Cells, Valproic Acid, Treatment Experienced

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Documented HIV seropositive infection by Western Blot, EIA assays or viral load. Aged 18 years old or older. Viral load <50 copies/ml for at least the previous 12 months. Circulating CD4+ cell count ³ 200 cells/ml. Taking HAART. Vital signs, physical examination and laboratory results do not exhibit evidence of diseases such as advanced cirrhosis and advanced liver disease (ALT or AST > 5 x upper limit of normal value). Karnofsky performance status 80%. Subject does not require and agrees not to take, for the duration of the study, any medication that is contraindicated with VPA. Willing and able to give informed consent. All participants will agree to abstinence or to used effective methods of contraception while on the study. Exclusion Criteria: Pregnant or breast-feeding women. Psychiatric or cognitive disturbance or illness that could preclude compliance with the study. Current use or use within four weeks prior to the baseline visit, of cytotoxic agents, systemic corticosteroids or any immunomodulatory agents such as intravenous immunoglobulin, or hydroxyurea. HIV vaccine within six months of screening visit Allergic reaction to VPA. Active intravenous drug users. History of bleeding disorders. Unstable or treated hypertension. Past-history of pancreatitis or chronic liver disease (ALT or AST > 5 x upper limit of normal value). However subject co-infected with hepatitis B or C can participate if ALT or AST is < 5 x upper limit of normal value. Renal failure (creatinine > 2 x upper limit of normal value). Ammonemia (> 2x upper limit of normal value). Taking Zidovudine (AZT), or combination of drugs containing AZT like Combivir or Trizivir. However this subject will be asked to switch to another NRTI,at least two weeks prior to Valproic Acid initiation, to become eligible. Taking on daily basis: phenytoin, carbamazepine, phenobarbital, warfarin or aspirin. Subject has any of the following abnormal laboratory results Hemoglobin < 100 g/L. Absolute neutrophil count < 0.75 x 10 9 cells/L. Platelet count < 50 x 10 9 cells/L. Subject suffering from urea cycle disorders.

Sites / Locations

  • BC St-Paul's Hospital/Immunodeficiency Clinic
  • Ottawa Health Research Institute/Immunodeficiency Clinic
  • Actuel Medical Clinic
  • Quartier Latin Medical Clinic
  • Montreal Chest Institute/Immunodeficiency Clinic
  • CHUL Ste-Foy

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Group 1

Group 2

Arm Description

HAART + valproic acid for 16 weeks followed by HAART alone for 32 weeks.

HAART alone for 16 weeks followed by HAART + valproic acid for 32 weeks.

Outcomes

Primary Outcome Measures

To assess the effect of VPA on HIV reservoirs measured by the frequency of resting CD4+ memory cells carrying HIV proviral DNA in peripheral blood of chronically HIV-infected subjects.

Secondary Outcome Measures

To assess the clinical and biological tolerance of VPA in chronically HIV-infected patients with undetectable viral load.
To explore the changes in CD4/CD8 ratio, as the size of reservoir is thought to be inversely correlated with the frequency of resting CD4+ memory cells carrying HIV proviral DNA.
To explore the frequency of CD4+ memory cell subsets (Tcm, Tpm and Tem) carrying HIV proviral DNA.
To explore level of T-cell activation after VPA intervention.
To assess levels of certain cytokines and chemokines, which are involved in T-cell proliferation and differentiation.

Full Information

First Posted
February 8, 2006
Last Updated
March 13, 2023
Sponsor
Jean-Pierre Routy
Collaborators
Canadian Foundation for AIDS Research (CANFAR), CIHR Canadian HIV Trials Network
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1. Study Identification

Unique Protocol Identification Number
NCT00289952
Brief Title
Valproic Acid and Its Effects on HIV Latent Reservoirs
Official Title
Use of Valproic Acid to Purge HIV From Resting CD4+ Memory Cells/ A Proof-of-concept Study
Study Type
Interventional

2. Study Status

Record Verification Date
March 2023
Overall Recruitment Status
Completed
Study Start Date
June 2006 (undefined)
Primary Completion Date
December 2012 (Actual)
Study Completion Date
December 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Jean-Pierre Routy
Collaborators
Canadian Foundation for AIDS Research (CANFAR), CIHR Canadian HIV Trials Network

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to examine whether the co-administration of valproic acid (Epival®), with highly active antiretroviral therapy (HAART) can reduce the size of HIV latent reservoirs in infected CD4 cells.
Detailed Description
Participants must be on HAART with a suppressed viral load (< 50 copies/ml) for at least the previous 12 months. They will be randomly assigned to one of two groups, one group will start the valproic acid right away at week 1 for 16 weeks, and the other group will wait until week 17 to add valproic acid to their treatment for 32 weeks. Subjects will be followed every four weeks for one year and evaluated by a variety of assays, all carried out using well-established methods, to assess the main outcome defined by changes in HIV reservoir size measured by the mean frequency of resting CD4 memory cells carrying HIV proviral DNA.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HIV Infections
Keywords
HIV infections, Histone deacetylase Inhibitor, HIV Reservoirs, Peripheral Blood Mononuclear Cells, Valproic Acid, Treatment Experienced

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Crossover Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
50 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Group 1
Arm Type
Experimental
Arm Description
HAART + valproic acid for 16 weeks followed by HAART alone for 32 weeks.
Arm Title
Group 2
Arm Type
Experimental
Arm Description
HAART alone for 16 weeks followed by HAART + valproic acid for 32 weeks.
Intervention Type
Drug
Intervention Name(s)
Valproic Acid
Intervention Description
Oral valproic acid twice daily for 16 or 32 weeks. Dosage varies based on plasma levels.
Intervention Type
Drug
Intervention Name(s)
HAART
Intervention Description
As per standard of care.
Primary Outcome Measure Information:
Title
To assess the effect of VPA on HIV reservoirs measured by the frequency of resting CD4+ memory cells carrying HIV proviral DNA in peripheral blood of chronically HIV-infected subjects.
Time Frame
16 or 32 weeks
Secondary Outcome Measure Information:
Title
To assess the clinical and biological tolerance of VPA in chronically HIV-infected patients with undetectable viral load.
Time Frame
16 or 32 weeks
Title
To explore the changes in CD4/CD8 ratio, as the size of reservoir is thought to be inversely correlated with the frequency of resting CD4+ memory cells carrying HIV proviral DNA.
Time Frame
48 weeks
Title
To explore the frequency of CD4+ memory cell subsets (Tcm, Tpm and Tem) carrying HIV proviral DNA.
Time Frame
48 weeks
Title
To explore level of T-cell activation after VPA intervention.
Time Frame
48 weeks
Title
To assess levels of certain cytokines and chemokines, which are involved in T-cell proliferation and differentiation.
Time Frame
48 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Documented HIV seropositive infection by Western Blot, EIA assays or viral load. Aged 18 years old or older. Viral load <50 copies/ml for at least the previous 12 months. Circulating CD4+ cell count ³ 200 cells/ml. Taking HAART. Vital signs, physical examination and laboratory results do not exhibit evidence of diseases such as advanced cirrhosis and advanced liver disease (ALT or AST > 5 x upper limit of normal value). Karnofsky performance status 80%. Subject does not require and agrees not to take, for the duration of the study, any medication that is contraindicated with VPA. Willing and able to give informed consent. All participants will agree to abstinence or to used effective methods of contraception while on the study. Exclusion Criteria: Pregnant or breast-feeding women. Psychiatric or cognitive disturbance or illness that could preclude compliance with the study. Current use or use within four weeks prior to the baseline visit, of cytotoxic agents, systemic corticosteroids or any immunomodulatory agents such as intravenous immunoglobulin, or hydroxyurea. HIV vaccine within six months of screening visit Allergic reaction to VPA. Active intravenous drug users. History of bleeding disorders. Unstable or treated hypertension. Past-history of pancreatitis or chronic liver disease (ALT or AST > 5 x upper limit of normal value). However subject co-infected with hepatitis B or C can participate if ALT or AST is < 5 x upper limit of normal value. Renal failure (creatinine > 2 x upper limit of normal value). Ammonemia (> 2x upper limit of normal value). Taking Zidovudine (AZT), or combination of drugs containing AZT like Combivir or Trizivir. However this subject will be asked to switch to another NRTI,at least two weeks prior to Valproic Acid initiation, to become eligible. Taking on daily basis: phenytoin, carbamazepine, phenobarbital, warfarin or aspirin. Subject has any of the following abnormal laboratory results Hemoglobin < 100 g/L. Absolute neutrophil count < 0.75 x 10 9 cells/L. Platelet count < 50 x 10 9 cells/L. Subject suffering from urea cycle disorders.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jean-Pierre Routy, MD
Organizational Affiliation
Royal-Victoria Hospital/McGill University Health Centre
Official's Role
Principal Investigator
Facility Information:
Facility Name
BC St-Paul's Hospital/Immunodeficiency Clinic
City
Vancouver
State/Province
British Columbia
ZIP/Postal Code
V6Z 1Y6
Country
Canada
Facility Name
Ottawa Health Research Institute/Immunodeficiency Clinic
City
Ottawa
State/Province
Ontario
ZIP/Postal Code
K1H 8L6
Country
Canada
Facility Name
Actuel Medical Clinic
City
Montreal
State/Province
Quebec
ZIP/Postal Code
H2L 4P9
Country
Canada
Facility Name
Quartier Latin Medical Clinic
City
Montreal
State/Province
Quebec
ZIP/Postal Code
H2L 5B1
Country
Canada
Facility Name
Montreal Chest Institute/Immunodeficiency Clinic
City
Montreal
State/Province
Quebec
ZIP/Postal Code
H2X 2P4
Country
Canada
Facility Name
CHUL Ste-Foy
City
Ste-Foy
State/Province
Quebec
ZIP/Postal Code
G1V 4G2
Country
Canada

12. IPD Sharing Statement

Citations:
PubMed Identifier
23195668
Citation
Routy JP, Angel JB, Spaans JN, Trottier B, Rouleau D, Baril JG, Harris M, Trottier S, Singer J, Chomont N, Sekaly RP, Tremblay CL. Design and implementation of a randomized crossover study of valproic acid and antiretroviral therapy to reduce the HIV reservoir. HIV Clin Trials. 2012 Nov-Dec;13(6):301-7. doi: 10.1310/hct1306-301.
Results Reference
derived
PubMed Identifier
22276680
Citation
Routy JP, Tremblay CL, Angel JB, Trottier B, Rouleau D, Baril JG, Harris M, Trottier S, Singer J, Chomont N, Sekaly RP, Boulassel MR. Valproic acid in association with highly active antiretroviral therapy for reducing systemic HIV-1 reservoirs: results from a multicentre randomized clinical study. HIV Med. 2012 May;13(5):291-6. doi: 10.1111/j.1468-1293.2011.00975.x. Epub 2012 Jan 26.
Results Reference
derived
Links:
URL
http://www.hivnet.ubc.ca/e/home/
Description
Canadian HIV Trials Network (CTN)

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Valproic Acid and Its Effects on HIV Latent Reservoirs

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