Lymphocyte Infusions for the Treatment of HIV-Infected Patients Failing Anti-HIV Therapy

This is an interventional treatment trial for HIV Infections focused on measuring HIV/AIDS, HLA-B*57, Cell Transfer, HIV, treatment experienced Read More

• INCLUSION CRITERIA RECIPIENT:

Under this protocol, cell recipients must fulfill all of the following characteristics and conditions:

Greater than or equal to 18 years old

Ability to sign informed consent

For women of child-bearing potential, negative result on a serum or urine pregnancy test; in addition, men and women of childbearing potential must agree to practice abstinence or use two methods of birth control/contraception (condoms, diaphragm or cervical cap with spermicide, IUD, or hormonal-based contraception) for at least 4 weeks after each cell infusion

Willingness to comply with study requirements and procedures including storage of blood for possible future use to study HIV/AIDS, related diseases, or the immune system

Willingness to permit HLA testing

Hematocrit greater than or equal to 27 percent, platelets greater than or equal to 25,000/mm (3)

No significant underlying cardiac, renal, or hepatic disease (Creatinine less than 2.0 mg/dL; aspartate aminotransferase (AST) and alanine aminotransferase (ALT) less than 150 U/mL)

HIV infection must be confirmed by ELISA and a confirmatory test (e.g. western blot if not previously documented, and patients must be under the care of a primary care physician.

Viral load greater than 10,000 copies/mL on available optimized combination antiretroviral therapy, to include at least 3 drugs, one of which is a non-nucleoside reverse transcriptase inhibitor (NNRTI), integrase inhibitor, or protease inhibitor. Patients not on combination antiretroviral therapy will be eligible, but must be willing to resume combination antiretroviral therapy and to have had a viral load greater than 10,000 copies/mL after at least 2 weeks of therapy.

Failure or intolerance of at least two previous combination antiretroviral regimens. Failure will be defined as an HIV viral load greater than 400 copies/mL while taking a given regimen.

Recipient must be taking appropriate prophylaxis for opportunistic infections, as per Public Health Service (PHS) guidelines, unless there is intolerance to available medications.

Screening CD4+ cell count less than or equal to 350 cells/mm(3) obtained within 6 weeks prior to study entry.

EXCLUSION CRITERIA FOR RECIPIENT:

An individual will be ineligible to receive cells if one or more of the following conditions are present:

Discordance with donor on antibody status of EBV, CMV, or HHV-8 if donor is antibody positive for EBV, CMV, or HHV-8.

Malignancy requiring systemic therapy, or a history of malignancy that required myelotoxic chemotherapy.

Active untreated opportunistic infection that requires systemic therapy. Patients with opportunistic infections who have received greater than 2 weeks of therapy will be eligible.

Is pregnant or breast feeding.

Severe psychiatric disorder that would interfere with adherence to protocol requirements. Individuals who have a stable psychiatric condition may be eligible.

Current use or a history of treatment with investigational agent(s) within 3 months of protocol enrollment. ARVs obtained through expanded access programs are permitted.

Current use or a history of treatment with a systemic corticosteroid, immunosuppressive, or cytotoxic agent within 30 days of protocol enrollment.

Any other medical condition for which the investigator believes cell transfer may be contraindicated.

Ever been diagnosed with autoimmune vasculitis.

INCLUSION CRITERIA DONOR:

Donor eligibility criteria as specified by the FDA will be followed, except for HIV testing. All donors will be HIV positive as per protocol and as described in the IND application. Under this protocol, cell donors must fulfill all of the following characteristics and conditions:

Greater than or equal to 18 years old.

Ability to sign informed consent.

For women of child-bearing potential, negative result on a serum or urine pregnancy test.

Willingness to comply with study requirements and procedures including storage of blood for possible future use to study HIV/AIDS, related diseases, or the immune system.

Willingness to permit HLA testing.

Matched to at least one HLA-B allele of the potential recipient. The

match will be at a two-digit resolution HLA allele level of typing or higher.

Hematocrit greater than or equal to 30 percent, platelets greater than or equal to 100,000/mm(3), white blood cells greater than or equal to 3.0 times 10(9)/L.

No underlying cardiac, pulmonary, renal, or hepatic disease that would preclude patient from undergoing apheresis.

HIV infection must be confirmed by ELISA and a confirmatory test (e.g. western blot if not previously on record, and patients must be under the care of a primary care physician.

HIV infection for greater trhan or equal to 7 years.

For patients with a history of no or minimal (one or two nucleotide reverse transcriptase inhibitor (NRTI) drugs) prior antiretroviral therapy: CD4+ cell count greater than or equal to 400 cells/mm(3) and HIV viral load less than 50 copies/mL, with no recorded HIV viral load obtained after acute HIV infection greater than 2,500 copies/mL. For patients currently receiving antiretroviral therapy: no antiretroviral therapy for a period of at least 7 years prior to starting antiretroviral therapy, with CD4+ cell count greater than or equal to 400 cells/mm(3) and HIV viral load < 50 copies/mL at the time of initiation of antiretroviral therapy, and no recorded HIV viral load obtained after acute HIV infection > 2,500 copies/mL. HIV viral loads obtained during acute HIV infection (within 6 months of the estimated date of seroconversion) will not be utilized for study inclusion/exclusion.

Minimum wt of 110 lbs<TAB>

EXCLUSION CRITERIA FOR DONOR:

An individual will be ineligible to donate cells if one or more of the following conditions are present:

Ever having been diagnosed with any AIDS-defining illnesses

Positive results on screening test for any of the following tests: HCV enzyme immunoassay (EIA) repeat reactive/ recombinant immunoblot (RIBA) confirmed, HBV/HCV NAT, HTLV-I/II antibodies, T.cruzi antibodies, HBsAg, or serologic test for syphilis (with positive confirmatory treponemal-based assay), unless the patient has received adequate therapy for syphilis. Donors with a positive West Nile Virus NAT are deferred for 120 days.

Is pregnant or breast feeding

HLA homozygous donor who is haplo-identical to recipient

History of malignancy other than basal cell carcinoma of the skin, or in situ carcinoma of cervix or colon

ALT or AST greater than 2 times the upper limit of normal

Been diagnosed with malaria

Been diagnosed with Chagas disease

Been diagnosed with babesiosis

Received a dura mater (or brain covering) graft

Been diagnosed with any neurological disease

Relative had Creutzfeldt-Jakob disease

Had a transplant or other medical procedure that involved being exposed to live cells, tissues, or organs from an animal

Had a sexual partner or a member of the household have a transplant or other medical procedure that involved being exposed to live cells, tissues, or organs from an animal

Severe psychiatric disorder that would interfere with adherence to protocol requirements. Individuals who have a stable psychiatric condition may be eligible.

Current use or a history of treatment with investigational agent(s) within 3 months of protocol enrollment.

Current use or a history of treatment with a systemic corticosteroid, immunosuppressive, or cytotoxic agent within 30 days of protocol enrollment.

Any other medical condition for which the investigator believes apheresis may be contraindicated.